It is located in New Westminster overlooking the Fraser River and is the only hospital in the Lower Mainland that is immediately adjacent to a Skytrain station (Sapperton).

In 2020, inpatient bed capacity increased to 490 with the opening of the Mental Health Substance Use Wellness Centre (MHSUWC).

[2] Royal Columbian Hospital is a major regional critical care site providing a range of primary, secondary and tertiary services.

[5] In addition, the site is serviced by multiple medical specialties such as internal medicine, cardiology, gastroenterology, nephrology, orthopedics, otolaryngology, gynecology, urology and ophthalmology.

RCH is no longer part of the BC Cancer Community Oncology Network as of 2021; previously they were a Level 3 full service.

At the time, a hospital's function was to serve as a charitable place for the community's most poor to be able to access some form of healthcare, and was a common institution in England.

[10][11][12][13][14] Royal Columbian moved to its current location in the Sapperton area of New Westminster in 1889; the large property purchased meant the hospital could expand and build additional structures.

In the 1920s, the economic boom that took place allowed for the hospital to continue to reduce its debt load and expand where needed.

The standardization movement taking place in the United States provided footing to compel the municipalities to finally begin funding the hospitals that served their citizens.

The standardization movement made its way to British Columbia and Dr. Malcolm MacEachern, the physician from Vancouver General Hospital was at the forefront of it.

The centre added a wide range of treatment facilities and medical functions linked to sophisticated technology such as a CT scanner, which was officially opened May 31, 1980, by the Hon.

[18] Housed in the former nurse's residences building, the space was reutilized to include 30 beds to specifically care for patients with mental health issues.

[22] Currently, Royal Columbian is a Clinical Academic Campus affiliated with the Faculty of Medicine of the University of British Columbia, the first in the Fraser Health region.

Phase one of the project marked the construction of a new 75-bed mental health and substance use wellness centre (MHSUWC), which opened to patients in July 2020.

[27] Prior to completion in July 2020, the phase one facility was designated as an offsite medical centre to help with the Provincial Government's response to the COVID-19 Pandemic, however it was not used for this purpose.