At the cornerstone ceremony of 1891, the Reverend S. G. Smith states, “Hospital buildings cannot be much improved upon, as science has made them nearly perfect.” In the eyes of those who have worked hard for its completion, St. Luke’s Hospital (which opens in October 1892) is as “nearly perfect” as nineteenth century science and architecture can make it. The Right Reverend Mahlon N. Gilbert, Episcopal bishop of Minnesota, feels such pride in the new hospital that he is moved to claim in the 1892 annual report that “no hospital more perfect can be found in the land.”

The trustees choose Clarence H. Johnston, a St. Paul architect with a growing reputation, to design St. Luke’s. Hailed as one of the most important figures in Minnesota architecture, Johnston designs most of the pre-World War II University of Minnesota buildings, as well as thirty-five of the finest homes on Summit Avenue, many hospitals (including Miller Hospital), prisons and commercial buildings. At thirty years of age, Johnston is just hitting his stride when given the chance to design St. Luke’s, and many connected with the new hospital are pleased with the results. In designing the hospital, Johnston follows an emerging trend of architectural simplicity that begins to appear in St. Paul during the late 1880s. The Smith Park Court (1886) and the Pioneer Building (1889) are examples of this style.

In the words of Bishop Gilbert, “Not one dollar has been expended in mere ornamentation or display, yet its massive and dignified exterior will be an ornament to a city noted for its beautiful and imposing public and private edifices.”
Johnston incorporates ventilating shafts and many windows into the building, giving the wards cross-ventilation — an asset, considering Minnesota’s steamy summers. The design apparently succeeds; a dietitian who works in the third floor kitchen several decades later reports that there always is a cool breeze. The building has notable advances in nineteenth century patient care: gas and electric lights, two elevators and a complete system of speaking tubes and electric call buttons. The first two floors have private rooms and separate wards for men, women and children. On the third floor is a kitchen, laundry, drying room, ironing room, maternity room and an operating theater. The theater is a semicircular room with raised seats to accommodate fifty students. In the basement are an accident ward, a morgue and additional private rooms.