The hospital was founded as a result of a bequest by Alexander Gray (d. 1807), who was born in Elgin but worked as a surgeon for the East India Company.

[1] His will was contested by his family, but eventually his bequest of £20,000 'for the establishment of a hospital in the town of Elgin for the sick and poor of the county of Murray (Moray)' was proven in the Court of Chancery.

[1] 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.

Some patients who required urgent assistance were sent home critically ill lacking the paperwork from the Kirk minister, ultimately causing their death.

The first stage, completed in May 1995, created a new complex for obstetrics, gynaecology and paediatric services, three new operating theatres and five new lifts.