The Medway long barrows all conformed to the same general design plan, and are all aligned on an east to west axis. Each had a stone chamber at the eastern end of the mound, and they each probably had a stone facade flanking the entrance. They had internal heights of up to , making them taller than most other chambered long barrows in Britain. The chambers were constructed from sarsen, a dense, hard, and durable stone that occurs naturally throughout Kent, having formed out of sand from the Eocene epoch. Early Neolithic builders would have selected blocks from the local area, and then transported them to the site of the monument to be erected.