Exploring the role and significance of hospitals as agents of change in London from around 1680 to 1820, eight hospitals (Bethlehem, Chelsea, Christ's, Foundling, Greenwich, Royal London, St Bartholomew's and St George's) are used as case studies to investigate the interaction between the institution and its urban environment in terms of demographic trends, urban development and planning and the influence of the architects and surveyors of these institutions in the architectural design.