The stadium was built to host the national high school baseball tournaments, and opened on 1 August 1924.

In addition to the annual National High School Baseball Championship, played in August, the stadium hosts the annual National High School Baseball Invitational Tournament in March, a smaller, invitational tournament.

It also hosts Japan's American college football national championship game, the Koshien Bowl.

Legendary baseball player Babe Ruth played an exhibition game at Koshien on his Japan tour in 1934.

However, even if the opponents are the Yomiuri Giants, the away supporters rarely constitute more than one section high up in left field.

Due to its reputation as the main stage of high school baseball, Koshien plays a big part in many baseball manga series, including Touch, Cross Game and H2 by Mitsuru Adachi and in other author's works like Higuchi Asa's Ōkiku Furikabutte and Rookies by Masanori Morita and Ace of Diamond by Yuji Terajima.

The events of the two-hour Detective Conan special episode "Miracle at Koshien Ball Park!

In Silver Spoon, Ichiro Komaba is determined to get his baseball team to Koshien to go pro and make money for his family farm.

In an episode of the Netflix anime series Devilman Crybaby it is featured as the arena for a track and field event.