The hospital was designed by James Gillespie Graham, featuring a large classical block with giant Doric columns that supported a portico and was topped with drum tower and dome. Work on building the hospital at the western end of the town's High Street started in 1815 and the hospital opened on 1 January 1819, providing 30 beds that could be used for any parishioner of Moray who could produce a note of recommendation from their local minister of the established church. Often those of the Episcopalian or Catholic faith were turned away, causing conflict with the Burgh council on a number of occasions. Some patients who required urgent assistance were sent home critically ill lacking the paperwork from the Kirk minister, ultimately causing their death.