Cowane's Hospital with its garden is a very rare survival, the embodiment of a continuing civic institution adapting to changing requirements, and it epitomises the thriving nature of Scots Burghs in the early 17th century. By the start of the 21st century it was in a poor condition, seldom visited and without a sustainable use. With a detailed measured survey, a condition survey and surveys of the founder's statue and memorial plaques, furniture and the structure, the conservation plan was commissioned. Documentary research into the building and its context was included. Draft assessments of cultural significance, a draft Statement of Cultural Significance, conservation issues and policies and a draft business plan were commented on by stakeholders, leading to a revised and approved conservation plan. On the basis of this, a programme of repairs and alterations was made. The external works included re-slating with some dendrochronological research, re-harling and limewashing, sensitive window and door repairs. The conservation of the founder's statue was based on wide research and included the repair of extensive Civil War damage. The repair and strengthening of the fragile bowling green balustrade included removing metal cramps and other inappropriate repairs, keeping maximum original material and patina. Fine cast-iron entrance lamps by the Shotts foundry were repaired and reinstated. The internal works included renewing mechanical and electrical services, a new catering kitchen, decoration, picture hanging and lighting. New offices were provided, with good insulation and heating.
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