One of the oldest shrines of the region, it is the northernmost of the island's Pancha Ishwarams of Siva, venerated by Sri Lankan Tamil Hindus around the world from classical antiquity.

Hindus believe its adjacent water tank, the Keerimalai Springs, to have curative properties, which irrigation studies attribute to high mineral content sourced from underground.

The legendary sage Nagula Muni, shrunk by age and austerity while meditating at a cave in Keerimalai was likened to mongooses that frequented the area.

[3] Its adjacent water tank, the Keerimalai Springs attribution to curative properties has been related in irrigation scientific studies to its high mineral content, sourced from underground.

Dakshina Kailasa Puranam, a Sanskrit treatise on another Pancha Ishwaram, Koneswaram of Trincomalee, recalls events in the Naguleswaram shrine.

Arab navigators spread the wonders of the temple's springs to the West, and James Emerson Tennent, citing Lane's Arabian Nights elaborates on Keerimalai as the site of the shipwreck of Sinbad the Sailor during his sixth voyage, where he collected pearls, hyacinth and ambergris.

Two days later, on 18 October at 14:30, the Sri Lankan Air Force returned and bombed the temple during the Kedara Gowri fast when thousands of devotees were present, killing 180 Tamil civilians, including 5 infants.

Temple buildings, its ancient gopuram, the library housing palm leaf manuscripts and statues incurred substantial damage.

[5][6] On Monday 6 February 2012, a major reconstruction of the temple was completed under the authority of the chief priest, Sivasri Naguleswara Kurukkal, and Naguleswaram's Mahakumbhabhishekam took place.