In 1866, a hospital was added to supplement the existing almshouse. In that same year, Tewksbury first began accepting what were known as the "pauper insane". In 1879, Tewksbury was reorganized, and its population separated according to type of illness: 40% of the beds were given over to the mentally ill; 33% to almshouse inmates, and 27% to hospital patients. By the end of the 1880s, Tewksbury had become solely a hospital, serving a combination of mentally and physically ill. And by the 1890s, the original 1854 wooden almshouse building had been torn down, and the remaining almshouse buildings were repurposed for hospital use. Some of these would remain standing until the 1970s.