Administratively, Neuwerk forms a homonymous quarter of the city and state of Hamburg, Germany, and is part of the borough Hamburg-Mitte.

At low tide one can reach the island on foot or on a Wattwagen, a horse-drawn mud flat coach, from Cuxhaven.

During the summer the vessel MS Flipper makes a daily trip at high tide from the "Alte Liebe" port in Cuxhaven to the island.

Because the Elbe was vital to Hamburg, a member of the Hanseatic League, the city's merchants with those from Bremen and Stade obtained the permission (a deed of 24 April 1286[4]) from Albert II, Duke of Saxony and his minor nephews Albert III, Eric I and John II, altogether co-ruling feudal lords of the Land of Hadeln of which Neuwerk formed a part then, to maintain a permanent fire on a mud flat island, then named O or Nige O, in the mouth of the Elbe.

[5] On 1 November 1299 Albert III and John II allowed the Hamburg and other seafaring merchants to build a fortified tower, named the new work (Neuwerk).

The current tower dates to 1367, 1369, or 1377 (accounts vary), built after a fire destroyed its wooden predecessor.

On 3 September 1915 lightning struck the Zeppelin LZ 40 (L 10), causing it to crash into the North Sea near Neuwerk, with the loss of the entire 20-man crew.

In 1946 an 18 kW wind turbine, 15 metres (49 ft) in diameter, installed to economize on diesel fuel, helped power the lighthouse and residences on the island.

[8] In 1969 Hamburg waived older rights on harbour estate in Cuxhaven in favour of Neuwerk and Scharhörn.