Almost all settlement exists within a narrow corridor stretching along the Pacific Highway between the Main Northern railway line and the Hunter River - Coquun.

Within the zone residential development is confined to 3 small areas measuring only 0.137 square kilometres (0.053 sq mi) in total.

[7] On Maitland Road there is Hexham Park which has a number of facilities including a cricket pitch, rugby union field, lights, amenities and a grandstand.

Coal arrived via the Richmond Vale Railway and a right-angle crossing (across the Main North government line) from 1856 until November 1967.

[19] There was a large rail yard called the Hexham Exchange Sidings to allow J & A Brown coal trains to be taken over the government line to Carrington.

[22] and the loader was dismantled soon afterwards.. Another timber wharf had been built in 1829 by the Sparke family for the loading and unloading of goods travelling between Newcastle and Maitland.

[23] This wharf was located on the south bank about 600 m (1,969 ft) upstream from the current bridges across the Hunter River - Coquun.

[24] This was near the Wheatsheaf Hotel which was originally built in 1827 by Andrew Sparke[25] and later operated by John Hannell, whose tomb is nearby.

[18](The company has a depot to the west, across the Pacific Highway and Great North Railway, at the end of what is now Woodlands Road.)

After it was constructed, the first Hexham bridge was built in 1952 with a centre lifting span so small ships could travel to this wharf.

This loader was later taken over by Peko-Wallsend in the 1960s, which also built six 610 t (600 long tons) coal silos (painted green) on the river bank and conveyors across the railway and highway to expedite loading.

[26] Milk was also transported by small boats to the Hunter Valley Dairy Co-operative factory after it was opened at Hexham in 1927.

Hexham's central location, with ready access to river, road and rail transport, has made it a key crossroads in the lower Hunter and influenced its industries.

[27][28] Hexham's central location has seen the establishment of petrol stations, fast food outlets, warehouses and saleyards for heavy vehicles and caravans.

The mosquito species Ochlerotatus alternans is common in the area and adults, famed for their size and ferocity, are referred to as "Hexham Greys".