In 1970, historian and anthropologist Ricardo Alegría of the Institute of Puerto Rican Culture (ICP) proposed a revival of this tradition in the form of a festival to Rafaela Balladares de Brito, a then community leader and renown resident of San Sebastian Street, with the purpose of creating an event that would celebrate Puerto Rican culture while raising funds for the Colegio de Párvulos, a nearby Catholic elementary school directed by Sisters of Charity.

[12] The 2020 celebration was momentarily cancelled in the aftermath of the January 7 earthquake that occurred in southwestern Puerto Rico but was quickly reinstated by mayor Carmen Yulín Cruz.

[13] Although the festival today still maintains its religious connotation in the form of its annual opening mass that is dedicated to its namesake, it has grown to become an important social and cultural event beyond its patronal origin.

[6] One of the most iconic elements of the festival is the Comparsa de los Cabezudos (Spanish for "parade of the Big Heads"), a parade of large-headed figures with exaggerated and sometimes humorous facial expressions or characteristics, typically made of papier-mâché, that begins by the San Juan Cathedral to join the street wide celebrations, dancing and singing with the public.

Cabezudos originally depicted humorous archetypes from local and Puerto Rican folklore, such as El General (a local Emperor Norton-like figure) and Juan Bobo, but now have come to portray and even pay tribute to important people from the history of Puerto Rico such as Felisa Rincón de Gautier, Francisco Oller, Diplo, José Campeche, Maso Rivera, Juan Antonio Corretjer, Don Cholito, Rafael Tufiño, Andy Montañez, and even the co-founder of the modern festival himself, Ricardo Alegría, among others.