The Cowanes exported fish, coal and wool in exchange for luxuries such as prunes, saffron and spices which were supplied to the royal court of James V at Stirling Castle.

This was intended to provide for "twelve decayed guild brethren", that is, elderly members of the Merchant Guildry of Stirling who could no longer support themselves.

As with Mylne's other architectural work, the design shows contemporary Dutch influences, notably the form of the bell tower and crow-step gables.

Existing buildings on the site were demolished in early 1637, and the uneven ground was levelled by burning peat in order to shatter the hard underlying rock.

William Stevenson, gardener at the hospital from 1667, is recorded as having ordered plants from Holland, including apricot, peach and almond trees.

A bowling green was subsequently laid out, surrounded by balustraded terraces and Dutch-style parterres of box hedging with herbs and flowers.

[2] From around 1720 the trustees switched to a policy of providing for pensioners in their own homes, and the hospital was converted, by removing internal partitions, into a hall for use of the Merchant Guildry.

The works were designed by Francis Mackison, burgh architect of Stirling, in the Gothic Revival style, and included a new roof, and a timber gallery and panelling.

[1] During the 19th century, the Patrons of the Cowane's Hospital Trust began to invest in property, acquiring a substantial holding of lands.

[5] Subsequent negotiation led to an agreement that councillors would continue to form the majority of the Patrons, in line with the wishes of John Cowane, but that their voting rights on certain matters would be limited.

[11][12] In April, 2019, the Patrons of Cowane's Hospital Trust began a major conservation project at the Hospital initially concentrating on the restoration of the historic fabric of the building with specialist conservation work being carried out on the statue of John Cowane, the stained glass windows, forecourt lanterns and inscribed stone panels.