Discussions began in 1856 in the nearby town of Drayton which was soon overshadowed in development by the more dramatic growth of Toowoomba and therefore, by June 1859 a small house was rented in Russell Street for the purpose of providing hospital services.

By 1864 a timber hospital was constructed at the corner of James and Ruthven Street on land granted by the Colonial Government.

[1] For many years discussions were held about the inappropriateness of the hospital site, thought to be too close to the centre of the growing city.

The present James Street site was acquired in 1878, by which time Toowoomba was a large regional centre, servicing the requirements of a rich and fertile farming hinterland.

[1] The early buildings on the site were designed by Queensland Colonial Architect, FDG Stanley and included a large, two-storeyed complex with four wards each containing 16 beds.

The buildings constructed at this time were face brick with pointed-arched sandstone detailing, in the manner of many of Stanley's other large public buildings, including the Roma Street railway station and the Queensland Government Printing Office in William Street, Brisbane.

[1] Staff accommodation and a medical superintendent's residence was erected in 1889, and a Victoria Wing was added to the principal ward building in 1899 for a cost of £2250, designed by local architect William Hodgen.

[1] On 24 April 1912, Lady William MacGregor laid the foundation stone for a new nurses' quarters facing West Street, at what was originally adjacent to the entrance of the hospital.

Hodgen was born in Toowoomba and went to London to study architecture, returning in 1897 when he established private practice.

The design of Freshney House follows this trend, integrating a traditional Queensland two-storeyed building lined with deep double-storeyed verandahs, with Arts and Crafts motifs including art nouveau column and balustrade details, half-timbered gablets on the steeply pitched roof, and a pronounced entrance projection with over scaled classical detailing.

This building was constructed for the care of those with infectious diseases, on the principles of the miasma theory which suggested that because the germs were thought to be circulating in the air, health service accommodation should be isolated and maintained to allow the maximum flow of the air through the building, dispersing germs.

A report in the Darling Downs Gazette, of 1921 describes the isolation ward as being in a distant corner and under the shade of several large trees.

The building was designed to have a ward which be open to the weather and was protected by canvas blinds rolled down from the eaves.

This building does not remain on the site and was replaced by a new maternity wing in the 1950s which is now used for the care of acute psychiatric patients.

The site is 2 kilometres (1.2 mi) from the central business district of Toowoomba and is elevated, making it visible from a distance.

[1] Freshney House is a symmetrically arranged two-storeyed face brick building lined on both storeys with wide, timber-framed verandahs.

[1] The steeply pitched hipped roof of Freshney House is clad with corrugated iron and is half-gabled over the eastern and western ends and has projecting bays over the northern entrance wing.

The roof encompasses the upper-storey verandah awning, which is supported on timber columns with elongated art nouveau brackets.

[1] Beneath the generous verandahs, Freshney House is a face brick building with stone quoining and rendered window and door surrounds.

The building is lined with French doors, reflecting its original internal layout as separate bedrooms.

The principal entrance to the building off West Street is expressed by a small balcony like projection in the first-storey verandah supported on paired timber columns, and featuring a segmental arched opening in the fascia skirt, lined with dentils.

The first floor remains substantially intact, with original planning, and finishes including pressed metal ceilings.

The vents are distinguished by their large size and number and have pyramidal roofs and corrugated iron-clad faces.

The building has been altered internally, but retains much of its external form and fabric, with the exception of verandahs which have been removed.

[1] A small, unusually richly decorated building on the southern end of the site, adjacent to Freshney House is an 1896 morgue designed by Henry Marks.

The corrugated iron-clad, truncated hipped roof of the morgue is lined with decorative barge board details.

[1] In the south west corner of the site is what was an open air ward comprising a small timber-framed building on a concrete slab.

[1] The 1950s buildings on the site are all two to four storeyed face brick modern structures, characterised by long thin plans, horizontal window bands, rendered concrete awnings, and flat concealed roofs.

The former open air ward in the north-west corner of the site is a rare surviving example of this type of building demonstrating the early treatment of contagious diseases.