The district encompasses Eastham's original town center, with a cluster of well-preserved 18th- and 19th-century buildings.

The area served as the town's civic center due to its proximity to Salt Pond, which provided access to the Atlantic Ocean, and was a major transportation route.

The advent of the railroad in the 1870s shifted the town's economic and civic heart to the present center.

The Old Town district is 40 acres (16 ha) in size, with 42 mainly residential buildings contributing to its significance.

The oldest building in the district is the c. 1672 John Knowles House at 191 Locust Road.