Known for most of its length as Patrick Henry Road, the state highway runs 18.67 miles (30.05 km) from U.S. Route 33 (US 33) in Montpelier east to US 301/SR 2 in Hanover Courthouse.

SR 54 heads southeast and crosses the South Anna River and Kings Pond, an impoundment of Falling Creek, before entering the town of Ashland, where the highway becomes Thompson Street.

The state highway intersects CSX's RF&P Subdivision just south of the Ashland Amtrak station.

SR 54 continues east as England Street, a three-lane road with center turn lane, and passes to the south of the campus of Randolph-Macon College.

East of the Interstate, SR 54 reduces to two lanes and leaves the town of Ashland, becoming Patrick Henry Road again.