The Hospital comprised three main buildings fronting Macquarie Street.
The hospital now stands in the Central Pavilion.
The original North Wing is now Parliament House. The South Wing became the Colonial Mint and in turn, the Mint Museum.
In 1788 when the first of the 736 convicts who survived the voyage to Australia many arrived suffering from dysentery, smallpox, scurvy, and typhoid.
Knowing a hospital would have to be made Governor Phillip and Surgeon-General John White established a tent hospital to care for the worst cases.
A portable hospital was prefabricated in England from wood and copper which arrived in Sydney with the Second Fleet in 1790.
Upon Governor Macquarie’s arrival he discovered that the Sydney Cove's hospital was an affair of tents and temporary buildings.
Macquarie set aside land on the western edge of the Government Domain for a new hospital and created a new road Macquarie Street.
With the British Government refusing to provide funds to build the hospital Macquarie entered into a contract with a consortium of businessmen - Garnham Blaxcell, Alexander Riley and, later, D'Arcy Wentworth.
They were to receive convict labour and supplies and a monopoly on rum imports from which they expected to recoup the cost of the building and gain considerable profits. The contract allowed them to import 45,000 (later increased to 60,000) gallons of rum to sell to colonists and was signed on 6 November 1810.