For more than a century, Chicago’s Cook County Hospital was at the forefront of American medical education and innovation. It served as the site of the country’s first medical internship in 1866, first blood bank in 1937, and one of the first AIDS wards in 1983. The hospital was even known as “Chicago’s Ellis Island,” for its commitment to serving immigrants and the poor. But after it became vacant in 2002 and narrowly escaped demolition—it made the National Trust’s 11 Most Endangered Historic Places list in 2004—the regal 1914 Beaux Arts building was on life support. Thanks to tireless advocacy by nonprofit Landmarks Illinois, a coalition of developers and real estate companies formed Civic Health Development Group to save and reuse the building.

“Trees, ferns, and moss were abundant inside and outside, and some areas of the building were not structurally sound,” recalls Ian Kaminski-Coughlin, a project manager associate at Skidmore, Owings & Merrill (SOM), the architecture firm that led the hospital’s two-year rehabilitation. Last year, the building reopened with a 210-room Hyatt hotel, a food hall featuring predominantly women- and minority-run stalls, and office space. A medical history museum is forthcoming.

The hospital’s facade required the replacement of more than 4,500 terra cotta pieces. Inside, the team restored features such as a marble staircase, ornate plaster detailing, and terrazzo flooring. “Maintaining the spatial character was essential to preserving the building’s legacy and history,” says SOM managing partner Adam Semel. Former operating spaces became lofty guest rooms, and the lobby ceiling was returned to its original 25-foot height. “Cook County Hospital’s adaptive reuse is the first step in unlocking the value of the rest of the [Illinois Medical District],” Semel says.