Most likely it was decided by Robert II of Bassavilla, Lord of Ruvo, together with bishop Daniele to definitively build a cathedral after the city was razed to the ground by the barbarian invasions and the war events of the twelfth century.

In the modern age the Cathedral underwent various changes so much so that, as emerges from the ad limina reports of Bishop Gaspare Pasquali, in 1589 it could count on twelve side altars which later became fourteen.

Even in the first half of the eighteenth century the Cathedral was subject to expansion works: in 1744 the façade was lengthened by 2.40 meters (7 ft) per side and under the episcopate of Giulio De Turris the mother church was equipped in 1749 with a decorated wooden false ceiling and three canvases by Luca Alvese, also presented various chapels on both aisles: on the left aisle there were the chapels of the choir at night, of the Crucifix, of Saint Blaise, of the Blessed Sacrament and of Saint Lawrence, while on the right were builds the chapels of the Lady of Sorrows, the Saints Cosmas and Damian, the Lady of Constantinople the Archangel Michael and the Madonna of Pompeii.

In the first half of the twentieth century the aim was to eliminate all the aggregations and structural additions of the Baroque era, trying to restore the original church.

Between 1901 and 1925 a new ciborium was built on the model of that of the Basilica di San Nicola in Bari by Ettore Bernich, a polychrome stained glass window depicting the Immaculate was affixed.

The external arch depicts Christ flanked by two pilgrims, the Vergin Mary and St. John the Baptist and around them are arranged angelic figures and the twelve apostles.

At the end of the central nave there is the beautiful ciborium built in the nineteenth century to a design by the architect Ettore Bernich and which is inspired by that of the Basilica of San Nicola in Bari.

The underground heritage of the Ruvo Cathedral remained hidden for centuries until 1925, when some single-lancet windows emerged during the renovation works.

Some tombs have survived from the Peucetian age with a scarce funeral equipment but which may suggest an area used as a necropolis and inhabited due to the presence of a furnace.

On the other hand, the two mosaic floors found in Roman times date back to the existence of a domus built in the 2nd century and enlarged in the 3rd.

The two tombs rich in jewels come from the Middle Ages, moreover some pillars of an ancient building or church on which the Cathedral itself rests date back to the same period.