Following his graduation from Hofstra Law School, Paterson worked in the District Attorney's office of Queens County, New York, and on the staff of Manhattan borough president David Dinkins.

Paterson launched a campaign for a full term as governor in the 2010 New York gubernatorial election, but he announced on February 26, 2010, that he would bow out of the race.

During the final year of his administration, Paterson faced allegations of soliciting improper gifts and making false statements; he was eventually fined in excess of $62,000 for accepting free New York Yankees tickets.

[12] At the age of three months, Paterson contracted an ear infection that spread to his optic nerve, leaving him sightless in his left eye and with severely limited vision in his right.

[20][21] Paterson briefly ran in the Democratic primary for the office of New York City Public Advocate in 1993, but he was defeated by Mark Green.

[23] Describing Paterson's tenure in the Senate, The New York Times cited his "wit, flurries of reform proposals and unusual bursts of candor".

Paterson traded the possibility of becoming Senate majority leader for the opportunity to hold the largely ceremonial lieutenant governor post.

[29] Paterson led Spitzer's successful 2007 legislative effort to approve a bond issue that will provide at least $1 billion toward stem-cell research.

Spitzer and Paterson touted the measure partly for its economic development benefits, following California's $3 billion effort, which in turn had been prompted by the U.S. federal government halting funding for such research.

[31] He told a crowd gathered at the West Indian American Day Carnival Parade that he believed noncitizens should be granted voting rights.

The lieutenant governor's office remained vacant until September 22, 2009, when the New York Court of Appeals ruled in a 4–3 decision that Paterson's appointment of Richard Ravitch was constitutional.

[47] On October 24, 2008, Paterson's top aide, Charles J. O'Byrne, resigned from his post[48] following the revelation that he owed nearly $300,000 in back taxes.

[48] Although Paterson is a lifelong Democrat who was considered a liberal in the state Senate, he earned praise from some conservatives during his time as governor for making major spending cuts; for providing mandate relief; for enacting an inflation-indexed property tax cap and a school tax "circuit breaker"; and for his appointment of Blue Dog Democrat Kirsten Gillibrand to a vacant seat in the United States Senate.

[55] Paterson made reference in his speech to the economic woes being faced in the United States, calling them a "crisis", and promised to "adjust the budget accordingly".

[57][58][59] Paterson quickly signed five pieces of legislation on his first day in office: to add the New York State Department of Labor to the New York City Transit Track Safety Task Force; to eliminate a law that discouraged employers from holding blood drives; to change the way in which members are appointed to a state health and research board; to restore eligibility caps to certain senior employment programs; and to grant tax exemptions to several local development corporations in New York State.

[63] In May 2008, Paterson informed New York State agencies that they were required to recognize same-sex marriage licenses from other jurisdictions for purposes of employee benefits.

[67] Paterson reportedly described same-sex marriage as "beautiful", and contended that his decision was "the right thing to do"; the governor was enthusiastically cheered when he attended the 2008 gay-pride parade in Manhattan.

[74] Paterson later tapped former Senate Majority Leader and former political foe Joseph Bruno to support same-sex marriage in Albany.

[83] With AIG on the verge of collapse on September 16, 2008, and in the aftermath of Lehman Brothers filing for bankruptcy, Paterson publicly lobbied for a government bailout of the insurance giant.

[98] Paterson proposed to close the 81-year-old Reynolds Game Farm, in Tompkins county, the state's only remaining pheasant facility, but changed course following criticism from sportsmen's groups.

[104] By mandate of the New York Constitution, Paterson was tasked with appointing a temporary replacement until a special election in 2010 for the conclusion of the term of her Class 1 seat.

[109] Cuomo was cited by some analysts as a savvy Senate appointee because his appointment might dissuade him from mounting a primary challenge against Paterson in the 2010 gubernatorial election.

[117][118][119] Some sources and analysts doubted the reports' veracity, calling the Paterson camp's denials of any interest in appointing Kennedy "misdirection".

Paterson later admitted that he personally ordered his staff to contest Caroline Kennedy's version of events in the hours after she withdrew from consideration to be United States senator.

On September 23, 2009, the New York Court of Appeals reversed the Appellate Division's decision, holding Paterson's appointment of Ravitch to be constitutional.

[142] On December 20, 2010, the Commission on Public Integrity found that Paterson had lied about accepting five free World Series tickets and fined him $62,125.

[147] By February 2009, after the prolonged Senate appointment process, a Siena College poll indicated that Paterson was losing popularity among New Yorkers and showed Giuliani with a fifteen-point lead in a hypothetical contest.

[150] Paterson added that President Barack Obama would be the next African-American elected official to suffer from poor approval due to his skin color.

[155] On February 26, 2010, however, Paterson withdrew his bid for a full term as governor of New York "amid crumbling support from his party and an uproar over his administration's intervention in a domestic violence case involving a close aide".

[172] In March 2023, a building on Eagle Street, in Albany, New York was named after Governor Paterson to commemorate the 15th anniversary of assuming the governorship.