Originally created in 1974, the ward was initially within Hamilton District Council before the local government reforms in the 1990s.
The ward was a Labour stronghold as the party successfully won the seat at eight of the 10 elections and held the seat for 23 years consecutively after gaining it from the Scottish National Party (SNP) in 1980.
In 2007, the ward was abolished and replaced by the multi-member Hamilton West and Earnock ward as council elections moved to a proportional voting system – the single transferable vote – following the implementation of the Local Governance (Scotland) Act 2004.
The Hillhouse ward was created in 1974 by the Formation Electoral Arrangements from an area in the west of the former Hamilton Burgh.
In 1998, the Third Statutory Reviews of Electoral Arrangements saw the ward's eastern boundary amended to run along Hillhouse Road and the southern boundary amended to take in streets around the south of Townhill Road.