Like the original game, it follows James Sunderland, a widower, who returns to the eponymous town in Maine upon receiving a letter from his deceased wife, Mary, who claims to be waiting there for him.

[1] Masahiro Ito and Akira Yamaoka, who served as creature designer and composer for the original game respectively, took an active part in development.

[7] The playable character is James Sunderland (Luke Roberts), a man drawn to the town by the possibility of seeing his deceased wife, Mary (Salóme Gunnarsdóttir).

[5][8][9] During his exploration of Silent Hill, James encounters Angela Orosco (Gianna Kiehl), a troubled and suicidal nineteen-year-old girl searching for her mother; Eddie Dombrowski (Danny Kirrane [appearance], Scott Haining [voice]), an overweight, bullied, and paranoid man;[9][10] and Laura (Evie Templeton), a mischievous but innocent 8-year-old girl who knew Mary when she was alive and dislikes James.

[9] James arrives in Silent Hill after receiving a letter from his wife Mary, who died three years earlier from a degenerative disease.

He meets Angela and dismisses her warning that the town is dangerous, but finds it inhabited by inhuman creatures, and himself stalked by an indestructible monster, Pyramid Head.

He traverses a decrepit prison, where he rescues Angela from a monster representing her father, whom she killed after enduring years of his sexual abuse.

She expresses disbelief at her apparent death and recounts Mary's memories, including James forgetting a videotape at the Lakeview Hotel during their last vacation.

The ending varies based on the player's actions: in "Leave", James tells Mary that he resented her for her illness and hostility toward him—fueled by her feelings of inadequacy and fear of her death—leading him to kill her to free them both.

Sensing his regret, Mary forgives him, giving him her real final letter, in which she tells James that he made her happy and encourages him to live.

Two joke endings feature James discovering a Shiba Inu orchestrated the game's events ("Dog") or being abducted by aliens ("UFO").

[11] Konami issued a separate statement, with the publisher remarking, "We don't have any specifics to share at this time, but we can say while Bloober Team will continue to produce their own original content, we’re excited at the chance to collaborate with them on potential projects across our various IP".

[13][14] An internet leaker alleged that the images were taken from an internal test demo Bloober Team developed to pitch the project to Konami, and as a result did not represent the final title.

[19] It was confirmed at the presentation that creature designer Masahiro Ito and original composer Akira Yamaoka would return to contribute to the remake.

[28] Jason Faulkner of Game Revolution gave Silent Hill 2 a perfect score, and wrote that it "sets a new golden standard when it comes to remakes", and the story is "carried over completely intact, honoring the original narrative while adding depth where appropriate.

"[40] Regarding its atmosphere, Dalton Cooper of GameRant wrote that "The Silent Hill 2 remake is a genuinely scary game without relying too much on jump scares.