Construction began in 1868, with the cost estimated at $800,000. Cost-saving measures included the construction of a new dock on the Hudson so that building materials could be shipped more directly to the site, quarrying and cutting the foundation stones on site, mixing concrete from local materials and hiring local craftsmen instead of a general contractor. The board also deviated from the plan it had sent the state, in particular by building a shorter female wing when it came to believe that fewer patients of that sex would be admitted. As a result, it is one of the few Kirkbride hospitals to have been built with asymmetrical wings.