Prior to becoming part of the Nakasendō, it was the tenth of eleven stations along the Kisoji, a minor trade route running through the Kiso Valley.
By 1971, some 20 houses had been restored, and a charter was agreed to the effect that no place in Tsumago should be "sold, hired out, or destroyed".
Despite its historical appearance, however, Tsumago is fully inhabited, though with tourist shops as the town's main business.
A quiet portion of the original highway has been preserved between Tsumago and Magome, the next post town (also restored).
Also, so guests do not have to walk the path twice to return to the beginning of the hike, bus service is provided between the two ends of the road.