The Western General Hospital has its origins in the poorhouse for the parish of St Cuthbert’s.  At one time, paupers of the parish were maintained on the poor fund, later augmented by a tally on beer and the issue by the parish of licences to beg. No accommodation was provided. In 1744 it was decided to remedy this by building a poor house. It was not until 1761 that the poor house was opened on the site of the present Caledonian Hostel. The institution included a school where orphans could be taught a trade or craft.

In 1865 the city’s Medical Officer of Health, Henry Littlejohn, found that his poor house was in an insanitary condition and ordered improvements to be made. In Edinburgh at that time there were three poor houses - Canongate, St Cuthbert’s and Craiglockhart. It was suggested that the two former institutions should be combined. St Cuthbert’s resisted the suggestion and in 1868, opened a new poor house on land purchased from the Fettes Trust.

The new building was known as Craigleith Hospital and Poorhouse. It continued to serve the needs of the parish’s paupers until 1914 when the hospital was taken over by the army and used for the treatment of forces casualties.

In 1929, the Local Government (Scotland) Act was passed, becoming operative on 16th May 1930. This act discontinued the parish councils and transferred their poor houses and poor-law hospitals to the counties and large burghs. It also empowered these authorities to upgrade the former poor-law hospitals and make them available to the general public. Edinburgh Town Council took over Craigleith Hospital among others. A scheme of renovation and improvement was begun, the aim being to equip and staff the institution, as a fully efficient teaching hospital. As a municipal hospital, Craigleith changed its name to the Western General Hospital with 280 beds now available.  In 1933 it was provided with a residence for 12 medical students, and in 1936, a nurses’ home was built.

A high proportion of the patients referred to the municipal hospitals were the chronically sick and aged. The local authority was legally empowered to charge patients for their accommodation and treatment. Members of the Royal Infirmary’s League of Subscribers were admitted free from 1945; their maintenance being paid out of RIE funds.

In 1941, as a result of the 2nd World War, many members of the Polish army found their way to Britain. Among them were some medical specialists from Polish medical schools, and a number of medical students. On the 24th February 1941, the President of the Polish Republic, then in exile in London, issued a decree officially instituting the Polish School of Medicine at Edinburgh, and on the same day, Edinburgh University signed an agreement with the Polish exiled government. Part of the Western General Hospital, with 120 beds, was set apart as the Polish or ‘Paderewski’ Hospital.  After 1945 the school was no longer needed as Polish universities were able to re-open.  The last students from it graduated in 1949.

The Western has never been a general hospital in the same sense as, say, the Royal Infirmary. It has, rather, built up a number of specialist units such as the coronary and the gastrointestinal units. It has also the regional units for radiotherapy and neurosurgery.

In 1948, the Western became part of the Northern Hospitals Group of the South Eastern Regional Hospital Board. In 1974 it became part of the North Lothian District of Lothian Health Board. In 1986 it became part of the Royal Victoria, Western and Northern General Unit of Lothian Health Board. At this time, departments of Leith Hospital began to be transferred to it. Presently it is part of the Lothian University Hospitals NHS Trust.