Overlooking the ancient Tamil port towns of Manthai and Kudiramalai, the temple has lain in ruins, been restored, renovated and enlarged by various royals and devotees throughout its history.

Mathoddam finds mention as "one of the greatest ports" on the seaboard between the island and Tamilakkam in the Tamil Sangam literature of the classical period (600 BCE – 300 CE).

[9] Hugh Nevill wrote in 1887 of the illustrious city of Mathoddam "A renowned shrine grew into repute there dedicated to one Supreme God symbolized by a single stone, and in later times restored by a Saivaite after lying long in ruins.

'"[10] One of the five ancient Iswarams of Lord Shiva on the island, Ketheeswaram joins Koneswaram (Trincomalee), Naguleswaram (Keerimalai), Tenavaram (Tevan Thurai) and Munneswaram (Puttalam) as a renowned and highly frequented pilgrimage site from before 600 BCE.

[14][15] The Karaiyar people claimed to be related to several classical period public figures hailing from the international port town, including the creator of the oldest extant Tamil literature by an Eelam Tamilian, the Sangam poet Eelattu Poothanthevanar.

Ketisvaram temple and the waters of the Palavi tank by its side are heralded in the Saiva work Tevaram in the 6th century CE by Sambandar.

After a gap of almost 400 years in the 1910s, local Tamils, under the urging of Hindu reformer Arumuka Navalar, came together and built the present temple.

With the restoration of the ancient and holy Palavi Teertham or pond in 1949, a major effort was made to improve the temple environs.

As part of the civil war that has plagued the country since the Black July pogrom of 1983 the temple is currently occupied by the Sri Lankan Army.

While granite work preparations were in progress, the army took over the Temple and its environs in August 1990 and continued to occupy the site for several years.

In this chapter is narrated the incident of how, at one time long ago, the God of Wind (Vayu) uprooted the three towers of the great mountain Maha Meru in order to keep off Athichedan — who fought against him, obstructing the great mountain with thousands of adorned summits resembling serpents’ heads — and deposited one of these towers at Thiruketheeswaram.