The hospital's design was reflective of the third stage of development of facilities for the mentally ill, after the Kirkbride Plan and the cottage/colony system. It also reflected the advent of roads rather than railroads as major transport arteries, as it was not located near any railroad lines. Its buildings were designed in the Colonial Revival style by Gordon Robb, with landscaping, based on principles laid down by the Olmsted Brothers, by R. Hayward Loring. At its peak, the facility had a patient population of nearly 2,000. The grounds included the Met-Fern cemetery, a burial site it shared with the Fernald School.