Today the town's economy is also heavily influenced by its proximity to the air force base CFB Greenwood in nearby Kings County.

The early records of the Board of Trade were lost in the Great Fire of 1911 but from the reports of its initial activities, the board was formed out of a need to vigorously pursue the issues of the day which affected business and industry - railway schedules and rates, street lighting and a variety of matters involving the municipal government of the day.

Two merchants, Harry Reed and Gorden Gross, formed the Board, with newspaper publisher Fred Cox as their secretary-treasurer.

The town was located on the Dominion Atlantic Railway's (DAR) mainline from Halifax to Yarmouth and was also served by CN Rail's line from Bridgewater to Bridgetown (and on to Victoria Beach).

Soldiers Memorial Hospital is located in the town and provides tertiary care services for the eastern part of Annapolis County.

The provincial government funded construction of the 50-bed Heart of the Valley Long Term Care Centre in the town which opened in late 2009.

Middleton hosts an annual three-day festival called "Heart of the Valley Days" every summer, during the month of July.

In 2009, as part of Middleton's centenary celebrations, the second Heart of the Valley International Town Criers Challenge was held.