In 1869, King County assumed ownership of 160 acres of farmland from the estate of John Thompson who had died without heirs. At this time, indigent persons unable to care for themselves were taken in by citizens who bid on their upkeep. Since the lowest bidders won these contracts, these arrangements proved inadequate.
The county convinced the Sisters of Providence to take the contract to operate the county hospital on the Thompson property, but they found the remodeled farmhouse to be unsuitable. In August 1878, the sisters built their own hospital at 5th Avenue and Madison Street in Seattle and cared for the county's poor there.
In May 1890, King County hired Dr. C. H. Merick to run the poor farm and hospital out of the old frame building. All county medical cases were handled there. After Dr. Merick died, Drs. Franz H. Coe and C. W. Sharples attended the patients.
In 1894, a modern, brick King County Almshouse and Hospital was completed. The 125-bed capacity was expanded to 225 beds with a new wing in 1908. Tuberculosis patients were housed in tents on the grounds until 1911. By the 1920s, the hospital was so crowded that patients' beds lined the corridors.
In 1931, King County opened its new hospital on First Hill in Seattle. The Georgetown facility became King County Hospital Unit 2 for convalescent patients.
In March 1956, the health department moved convalescent patients to the former Children's Orthopedic Hospital on Queen Anne Hill. The Georgetown building was sold for $109,500, and demolished soon afterwards.