The 1000 bed acute hospital has provided all of the medical services to the Island for over 50 years. During this period the fine, well designed stone building has suffered from piecemeal alterations and a lack of maintenance. While resolving the functional and logistical problems, a guiding principle of this successful refurbishment was to respect the original building and take advantage of the generous ceiling heights, high quality materials and natural ventilation. The project included a complete upgrading of the services infrastructure, a rationalisation and relocation of departments, and upgrading of all existing facilities over a five year period, while the hospital continued to function. Ann Noble Architects prepared the detailed Development Plan for this refurbishment, and designed and implemented the first phase of the works.