The winner of the Medal is judged to be the most outstanding project of the year, by definition making it 'a building, place or structure of exceptional merit', often winning multiple prizes across different award categories.

A cast circular bronze medal is awarded to the winner and usually affixed on the winning project in a prominent position.

Two exceptions were the awarding of the Medal to John Wardle Architecture for a private residence, Balnarring Beach House in 1997[2] and to Wood Marsh for the Yve Apartments on St Kilda Road in 2006.

The Dimity Reed Melbourne Prize established in 1997 has become another significant award that addresses the civic and public realm contributions of architecture to the city, but does not focus solely on the experience of the 'street'.

The first award for best public building in London was made to W. Curtis Green for Wolseley House at 157–160 Piccadilly.

The jury could recognise any building built within the past five years, with the objectives of the award listed as twofold —"Firstly, that buildings which notably contribute to the civic beauty and architecture of the cities of this State should be publicly singled out and acknowledged, in order that universal appreciation of their good qualities and emulation of their characteristics may be encouraged, and that through this means a widespread sense of civic responsibility may be developed and fostered in the architects and citizens of our State..." and secondly that "...due recognition by his fellow practitioners and fellow citizens may be made of the high achievement of the architect responsible for a building deemed worthy of this award...".

It was also noted that a competition was to be held for the design of the bronze plaque to be attached to the winning building, open to RVIA Members and students.

[8] The first medal was presented to Francis House at 107 Collins Street in Melbourne, a narrow fronted five storey office building with a ground level shopfront, designed by architects and cousins Blackett and Forster.

In 1936 the president of the RVIA described the purpose of the award was to "encourage excellence of design and public interest in street architecture, the Institute having decided to examine annually buildings completed during the previous three years and to award a medal for a building of exceptional merit".