The brook rises from its source south of Hulland Ward, and flows for most of its length through the countryside north-west of Derby before entering a culvert to the north of the city centre; it reappears from this culvert and runs through a short section of open channel on the other side of the city before joining the Derwent.

Originally the course of the brook passed through the city in an open channel, but it was successively bridged and piped over the years, and by Victorian times it was almost completely covered.

Although concealed, its presence could not be ignored, with a number of notable floods occurring in Derby before significant changes, including diversions and relief culverts were deemed necessary to prevent further inundations.

Beside the upper lake is a neoclassical style boathouse and fishing room, beyond is a "very handsome stone bridge",[2] where beneath the three arches, the brook also falls over a cascade.

It crosses beneath the Morledge, before it finally re-emerges from the culvert into the Mill Fleam at the Cockpit island, and then runs alongside the Bass recreation ground, until it reaches the River Derwent.

[6] It has been estimated that during a large storm the catchment can generate a flow of 50 cubic metres per second (1,800 cu ft/s), within thirteen hours of intense rainfall.

[7] The brook drains a catchment with a geology consisting of mainly Mercian mudstones and Siltstone, but with some Sandstone and Shales in the upper reaches.

The gaol or jail was located near the Cornmarket, and had underground cells beneath street level, that filled with floodwaters, "owing to a sudden rise" of the brook.

Herbert Spencer, who was an engineer in Derby at that time, described the flood: "A tributary of the river Derwent which runs through Derby, called the Markeaton Brook, was raised suddenly to an immense height by a local deluge of rain, and overflowed to the extent of producing in the main street a flood of some six feet in depth: the level attained being so unusual that it was marked by an iron plate let into the wall.

Residents living alongside the course of the brook were trapped in their houses, and produce from nearby allotments was uprooted and swept through the streets.

Opened in 1938, the largest of the diversion tunnels was called the Northern Flood Relief Culvert, and drains excess flows from the Markeaton and Mackworth brooks.

Flows from these inlets converge, and are then taken by the relief culvert eastwards for 2.2 km through the suburbs of Derby, to an outfall with the Derwent in Darley Park.

[18] The brook and its tributaries supports a range of flora and fauna, and includes two protected areas of ecological importance at Muggington Bottoms and Kedleston Hall.