When Skidmore, Owings & Merrill (SOM) took on the challenge of revitalizing the 100-year-old Cook County Hospital in Chicago, they faced a question that resonates with building professionals everywhere: how do you preserve a historic landmark while giving it a viable new future? The Beaux-Arts building, completed in 1914 and vacant since 2002, had deteriorated severely from decades of deferred maintenance, weather exposure, and vandalism. Yet SOM demonstrated that careful adaptive reuse of historic structures can restore both architectural grandeur and community purpose. This article examines the preservation strategies, material restoration techniques, and adaptive reuse approaches that transformed a threatened landmark into a mixed-use destination with a hotel, food hall, medical offices, and community spaces.
The Legacy of Cook County Hospital: From Medical Pioneer to Endangered Landmark
Cook County Hospital occupies a singular place in both Chicago’s architectural and medical history. Designed in the neoclassical Beaux-Arts style, the building once stood as the symbolic heart of the Illinois Medical District. Its monumental façade, characterized by symmetrical massing, ornate terra cotta ornamentation, and classical detailing, represented the civic ambition of early 20th-century public architecture. The building’s historical significance extends far beyond its architecture: it was here that the first blood bank in the United States was developed, and the hospital earned a reputation as “Chicago’s Ellis Island” for its dedicated treatment of poor communities and immigrants.
By the time the building closed in 2002, the facility had outlived its functional lifespan as a hospital. For nearly two decades, the landmark sat vacant, exposed to the harsh Chicago climate. Water infiltration through the deteriorating roof and facade caused widespread interior damage. Vandalism further compromised the building’s fabric. Demolition was a real possibility, a fate that has befallen countless historic structures across the United States when preservation costs appear prohibitive.
The decision to pursue adaptive reuse rather than demolition reflected a growing recognition among building professionals that historic masonry building preservation offers environmental, economic, and cultural benefits that new construction cannot match. Embodied carbon savings alone make adaptive reuse one of the most effective sustainability strategies available. For Cook County Hospital, SOM led a design-build collaboration with general contractor Walsh Construction, Wiss, Janney, Elstner Associates for structural engineering, and interior designers KOO to execute a $1-billion master redevelopment plan, with the hospital building as its first phase.
Structural Assessment and Façade Restoration: Rebuilding a Neoclassical Masterpiece
The Terra Cotta Restoration Challenge
The most visible and labor-intensive aspect of the restoration was the repair and replacement of the building’s terra cotta cladding. Cook County Hospital’s neoclassical façade features extensive terra cotta ornamentation, including cornices, pilasters, balustrades, and decorative panels. After a century of thermal cycling, freeze-thaw action, and moisture penetration, more than 4,500 individual pieces of terra cotta required replacement or repair.
The restoration team faced several technical challenges:
- Matching the original terra cotta composition, glaze color, and texture required custom firing using period-appropriate techniques
- Each damaged piece had to be individually assessed for either in-situ repair, removal and replication, or full replacement
- Anchoring systems for replacement pieces needed to meet modern seismic and wind-load standards without compromising the historic appearance
- Differential expansion between new and original terra cotta required careful thermal movement analysis
The project demonstrated that large-scale terra cotta restoration is feasible when the project team includes specialists familiar with historic glazing techniques and structural anchorage systems. The result is a façade that reads as historically authentic while meeting contemporary performance standards for weather resistance and structural integrity.
Addressing Structural Deterioration in a Century-Old Masonry Building
Beyond the terra cotta cladding, the underlying masonry structure required extensive investigation and repair. Moisture infiltration had compromised mortar joints, spalled brick units, and corroded concealed steel shelf angles and lintels. The structural engineering team conducted a thorough condition assessment using techniques including ground-penetrating radar, moisture mapping, and selective exploratory openings to document hidden conditions.
Key structural interventions included:
- Selective masonry demolition and rebuilding in areas where moisture damage had compromised structural capacity
- Replacement of corroded steel shelf angles that supported the terra cotta cladding at floor levels
- Repointing of mortar joints using a breathable lime-based mortar compatible with the historic soft brick
- Installation of concealed stainless steel ties to improve the connection between the masonry wythes and the terra cotta cladding
Building professionals working on similar projects can learn from the team’s approach to structural steel corrosion assessment and repair in masonry buildings, a common failure point in century-old structures where embedded steel elements are concealed from view until deterioration is advanced.
Modern Design Interventions: The Steel and Glass Canopy and Interior Transformation
The New Entrance Canopy: Contrasting Old and New
One of the most distinctive design decisions was the addition of a sliver-thin canopy of steel and glass marking the main entrance. This contemporary intervention replaced a bulky previous addition that had diminished the integrity of the historic façade. The new canopy makes no attempt to mimic the Beaux-Arts style; instead, it establishes a clear visual dialogue between the original masonry structure and the new programmatic uses within.
The steel and glass canopy required careful detailing to avoid damaging the historic masonry beneath. The canopy structure is independently supported, transferring loads directly to foundations rather than relying on the existing masonry walls. This approach eliminated the need for large anchor penetrations through the restored terra cotta. The design team also addressed preventing galvanic corrosion between dissimilar metals where the new steel framing interfaces with existing iron and steel elements embedded in the masonry, a critical detail for long-term durability.
Restoring the Grand Lobby to Its Original Grandeur
Inside, SOM restored the main lobby to its original height of 8 meters (25 feet). During the building’s hospital years, suspended ceilings and partitioning had lowered the lobby height and obscured the original Beaux-Arts detailing. The restoration team removed these later additions to reveal the full spatial volume, then meticulously restored the original red terrazzo flooring and ornate plaster moldings.
The lobby restoration followed a phased approach:
- Documentation of existing conditions through laser scanning and photographic survey before any demolition work
- Careful removal of non-historic partitions, suspended ceilings, and mechanical systems that had been added during the hospital era
- Assessment of original finishes to determine which could be restored in place versus requiring replacement
- Restoration of original red terrazzo flooring through deep cleaning, crack repair, and resealing
- Replication of damaged plaster moldings using period-appropriate techniques and materials
- Selection of contemporary artwork, lighting, and finishes that complement rather than compete with the historic fabric
The result is a space that immediately communicates the building’s original grandeur while making clear that a new chapter has begun. Select contemporary interventions signal the adaptive reuse without overwhelming the historic character.
Adaptive Reuse Programming: Transforming a Hospital into a Mixed-Use Destination
The Hotel Conversion Within a Challenging Building Footprint
One of the most innovative aspects of the adaptive reuse was the conversion of hospital floors into hotel guest rooms. The building’s relatively thin footprint, originally designed to maximize natural light and cross-ventilation for patient wards, proved well-suited to hotel room layouts. SOM and KOO configured 210 hotel rooms, each with unique layouts that respond to the existing window placement and structural bay spacing.
Some of the most distinctive guest rooms occupy the former operating rooms on the eighth floor. These spaces feature bands of windows that originally provided abundant natural light for surgical procedures, now offering guests dramatic views of the Chicago skyline. The conversion demonstrates how unusual hospital spatial configurations can become assets in hotel programming rather than constraints.
Community Amenities and Public Spaces
The adaptive reuse program extends well beyond the hotel. A food hall adjacent to the lobby provides a bright, welcoming space featuring 12 local vendors, primarily women-owned and minority-owned businesses. An expansive bar and lounge areas offer views through restored wood-framed windows, connecting interior spaces to the surrounding neighborhood.
A dedicated museum space within the restored building showcases the hospital’s significant role in medical history, including the development of the first US blood bank. This interpretive element ensures that the building’s legacy remains accessible to the public, even as its primary function has changed completely.
Preservation Strategies Comparison
| Building Element | Condition Found | Intervention Strategy | Key Consideration |
|---|---|---|---|
| Terra cotta cladding | Severe cracking, spalling, glaze loss on 4,500+ pieces | Custom replication with period-appropriate firing and glazing | Thermal expansion compatibility between old and new pieces |
| Masonry structure | Deteriorated mortar, spalled brick, corroded concealed steel | Selective rebuilding, lime-based repointing, stainless steel ties | Breathability and moisture management in historic assemblies |
| Steel and iron elements | Corroded shelf angles, lintels, and anchors | Replacement with galvanically compatible modern steel | Dissimilar metal isolation to prevent galvanic corrosion |
| Main lobby finishes | Obscured by dropped ceilings and partitions | Full restoration of terrazzo, moldings, and spatial volume | Compatibility of new sealants and coatings with historic materials |
| Wood-framed windows | Deteriorated frames, failed glazing, air leakage | Restoration of original frames with modern weatherstripping | Thermal performance improvement without replacing historic fabric |
Key Takeaways for Building Professionals
The Cook County Hospital adaptive reuse project, which earned a 2020 Landmarks Illinois Richard H. Driehaus Foundation Preservation Award for Adaptive Reuse, offers several lessons for building professionals engaged in historic preservation work:
- Invest in thorough condition assessment before design begins. The discovery of 4,500 damaged terra cotta pieces and extensive concealed steel corrosion underscores the importance of comprehensive investigation before establishing budgets and schedules.
- Plan for hidden conditions and maintain contingency reserves. Century-old buildings almost always reveal unexpected deterioration once finishes are removed and walls are opened.
- Design new interventions as clear contemporary additions rather than imitations. The steel and glass canopy succeeds because it respects the historic fabric without attempting to mimic it.
- Engage specialist trades early. Terra cotta restoration, historic plaster replication, and lime-based masonry repointing require skilled craftspeople who may need to be identified and contracted well in advance.
- Consider the adaptive reuse potential of unusual building configurations. The narrow footprint and operating room layouts became design assets rather than liabilities.
- Integrate community-serving uses. The food hall, museum space, and public lounges ensure the building serves the surrounding neighborhood, not just hotel guests.
SOM’s revitalization of Cook County Hospital demonstrates that the most challenging preservation projects often yield the most rewarding results. By combining rigorous structural assessment, meticulous material restoration, and thoughtful contemporary design, the project team transformed a severely deteriorated landmark into a vibrant mixed-use destination that honors the building’s past while securing its future. For building professionals considering adaptive reuse projects, this project provides a compelling precedent for what is possible when preservation expertise, design excellence, and community vision align.