Sir Edward Winter, who was the agent of the company, was instrumental in the establishment of the first British Hospital at Madras.

[4] In its early days, the hospital was housed at the Fort St. George and in the next 25 years, it grew into a formal medical facility.

The hospital moved out of the fort after the Anglo-French War and it took 20 years before it could settle in the present permanent place in 1772.

These trained personnel were posted to various dispensaries in the district headquarters of the then Madras Presidency to assist the qualified doctors.

By the end of the 20th century, the government decided to demolish the old building and replace it with two tower blocks at a cost of ₹ 1,050 million.

[9] In April 2007, the government decided to open pay-and-use wards with 200 beds and own nurses, to be maintained by the Tamil Nadu Medical Commission, at the hospital.

The tower blocks are constructed with structural glazing, aluminium composite panel cladding and Novakote finish.

Construction of an eight-storey block to house 23 outpatient departments began in August 2016 at a cost of ₹ 1014.5 million.

The tank, with a capacity to hold 13,000 litres of oxygen, would cater to the needs of the entire hospital when it becomes operational.

As of 2013, there were 231 beds for various ICUs at the hospital including for poly trauma, orthopaedics, medical emergencies, poison, surgical, cardiology, neurology and geriatrics.

An additional 15 beds for cancer ICU has been planned along with the commissioning of a linear accelerator for precise radiation therapy.

[14] In 2018, an integrated laboratory facility in the hospital was officially sanctioned to provide "seamless lab services".

[23] In March 2011, the state health department announced setting up of a genetic lab at the hospital to help in the early diagnosis of such diseases.

[25] It will be 1 km long, linking the hospital with nine points, including Chennai Central Railway Station, Evening Bazaar, Government Medical College and Ripon Buildings on Poonamallee High Road.

In April 2022, the government announced the construction of a new building at a cost of ₹ 650 million to replace the century-old Bradfield Surgical Block, which was destroyed by fire in the same month.