[6] In 1870, the Tianjin Massacre occurred and the situation in Shanghai became unstable, making the operation of the hospital very difficult for a while.

As the lease was due to expire on December 31, 1876, the hospital management began to discuss the relocation of the hospital in September 1874 after the difficulties were overcome, with the initial director, F. B. Forbes, favoring Heard's Garden.

In January 1875, newly appointed director William Keswick favored Endicott's Garden, although at that time the management was also considering purchasing land in Suzhou Creek for the hospital.

In 1875, the hospital began negotiations with the Shanghai Municipal Council (SMC) to purchase land on the north bank of the Suzhou Creek outside the French Concession.

The SMC agreed to the request and intended to place the hospital under the management of both the SMC and the Conseil D'Administration Municipale de la Concession Française de Changhai (authority of the French Concession), however the French were initially reluctant in order to maintain a certain degree of independence, however they simply could not afford to run the hospital and eventually compromised.

[8] After the relocation of the hospital, the management was transferred to the board of trustees, which was dominated by the SMC.

After purchasing the land to the east of the hospital in February 1890, wards, morgues, and autopsy rooms were constructed.

[10] On August 13, 1937, Japan attacked Shanghai, and the SMC attempted to take a neutral stance.

[11] Director G. Charnbers and the sisters transferred 70 patients to the Henry Lester Institute for Medical Research, while the rest of the staff took refuge in the relative safety of the French Concession, which was not occupied by the Japanese.

The name of the hospital remained unchanged after the handover, but was fully open to the Chinese.