Paterson has appeared in films and television series including Comfort and Joy (1984), Traffik (1989), Auf Wiedersehen, Pet (1986), Truly, Madly, Deeply (1990), The Witches (1990), Wives and Daughters (1999), Sea of Souls (2004–2007), Amazing Grace (2006), Miss Potter (2006), Little Dorrit (2008), Doctor Who (2010), Outlander (2014), Fleabag (2016–2019), Inside No.

[2] However, after school he chose to initially pursue a career based on an interest in architecture and spent three years as a quantity surveyor's apprentice before deciding to attend the Royal Scottish Academy of Music and Drama.

[3][2][4][5] Paterson made his professional acting debut in 1967,[4] appearing alongside Leonard Rossiter in Bertolt Brecht's The Resistible Rise of Arturo Ui at the Glasgow Citizens Theatre.

He remained there as an actor and assistant director until 1972, when he left to appear with Billy Connolly in the musical comedy The Great Northern Welly Boot Show at the Edinburgh Festival in 1972.

His first appearances in 1978 were as a police Sergeant of Scotland Yard in The Odd Job[7] and then in BAFTA award winning drama Licking Hitler.

Paterson would later recall that the biggest regret of his career was during this period, when in 1978 he failed to attend an audition for a role in the film Alien.

[5] He provided the voice of the Assistant Arcturan Pilot in Episode 7 of the original BBC Radio 4 version of The Hitchhiker's Guide to the Galaxy in 1978.

In television, his extensive and award-winning TV career includes a memorable portrayal of property villain Ally Fraser in series 2 of Auf Wiedersehen, Pet (1986).

[11] In television, much of his later work has been for the BBC, starring as Dr Douglas Monaghan in three seasons of the supernatural drama series Sea of Souls (2004–2007).

In 2005, he would take a role as Rob McKenna, a lorry driver and unknowing Rain God, in Fits the 19th, 20th, and 22nd of The Hitchhiker's Guide to the Galaxy: Quandary Phase.

In 2003, Paterson began broadcasting radio stories about his childhood in Glasgow, Tales From the Back Green on BBC Scotland, which led to them being published by Hodder in 2008 and appearances at many book festivals throughout the UK.

[12] He also played the key role of SIS Chief Percy Alleline in the 2009 BBC Radio 4 version of Tinker Tailor Soldier Spy.

[2][27][9] Paterson has published a series of book stories based on his childhood in Glasgow entitled Tales From The Back Green.