The game's premise is largely unchanged from its predecessor; players must build a profitable and unique tower block complete with various amenities and living accommodations, while balancing the needs of the occupants.

As in SimTower, offices and food courts can be built to generate income, as well as condos that can be sold to families.

There are plenty of new facilities that can be placed such as rented apartments, vending machines and public restrooms for food court patrons.

Another interesting addition is the ability for players to build two or more towers next to each other and join them with sky bridges.

Users can place billboards for Apple Computer (in Mac version only) and Sega, whilst there are tenants featuring real-world stores like GameWorks, Orange Julius or Air Jamaica.

A new addition of the game is the ability to expand the game using plug-ins released for download which would add new features, such as new facilities (e.g. additional shops, restaurants, and services, ranging from a Glico store to a swimming pool), new events, billboards, and movies, as well as other aspects of gameplay.

The easiest of the three scenarios, Hawaii has users building a mixed-use structure featuring condominia and hotels.

The advanced Tokyo level has users building a fast-paced tower with primarily offices and eventually other uses as well.

In this add-on, officially titled The Tower II - Christmas Story ～サンタクロースになれる聖夜～,[2] the player constructs a log building and collects Christmas-themed items whilst Santa can be spotted walking around.