When it opens in 2027, the new hospital will be three times larger than the existing facility and increase capacity from 148 beds to 204 beds, reflecting the growing needs of the Vancouver Island community. The hospital will expand capacity for inpatient and ambulatory care, with seven operating rooms, additional procedure rooms, an expanded birthing unit, pediatric spaces, outpatient clinic services, expanded diagnostic imaging, an expanded emergency department, and a rooftop helipad. Mental health services will be brought up to date with a 20-bed inpatient psychiatry unit and a four-bed psychiatric intensive care unit.

Island Health’s expanded hospital-based services will complement the myriad primary care and community-based health services in the region, enabling more equitable access to care wherever patients’ needs are best met. This integrated model puts as much focus on helping people stay healthy as providing high-quality critical and acute care services.

Culturally Responsive Design

Situated on a greenfield site at the base of Swuq'us (Mount Prevost), the hospital’s design responds to its natural surroundings and honors its Indigenous connection to the mountain. To create a feeling of respect and balance between nature and people, the architecture consists of organically assembled volumes forming a collective whole rather than a singular, large unit. ZGF started by pulling the hospital program apart and then massing around the landscape while maintaining orientation toward the mountain. The resulting L-shaped form enables targeted views of Swuq’us while reaching out into the community through human-scale connections at building entrances, outdoor spaces, and the forecourt parking area. This corner of the site is positioned as a center of gravity for the future planned community that will grow around the hospital in coming years.

Representatives from Cowichan Tribes and the Indigenous Advisory Council have provided essential project guidance from the outset. The hospital will serve Indigenous populations within the Cowichan Valley Regional District as well as those residing within the unceded and traditional territories of the Ditidaht, Pacheedaht, Ts’uubaa-asatx, Stz’uminus, Penelakut, Lyackson, Halalt, Malahat, and Cowichan Tribes.

The design demonstrates respect and inclusion for Indigenous cultures, forming architectural connections and opportunities for meaningful cultural features that aspire to express Indigenous values at the heart of the new hospital. Culturally safe spaces will accommodate an array of traditional healing practices and cultural protocols, including traditional foods, a Gathering Space, and within the Indigenous Health Department a short-term accommodation room for loved ones to support patients during their hospital stay.

Community Hall

Building on the notion of reaching out and connecting to the surrounding community, it was important to create a central gathering space that welcomes all members of the hospital and greater community. The two-story Community Hall, a lively public lobby and thoroughfare, will connect the upper and lower site entries with the future Diagnostic and Treatment block and Inpatient Unit tower. It acts as a social seam for the project, anchored in between the two main building masses like a river valley through the mountains, defined yet organic. Inspired by traditional Coast Salish Longhouses, the Community Hall utilizes timber framing, wood platforms, and vertical poles to form a signature armature of wood through the heart of the hospital, reinforcing its connection to the land.

Indigenous Gathering Space

Set within a garden, the Indigenous Gathering Space is a distinct, special timber building for traditional practices and cultural protocols. The space receives excellent daylight including morning light from the East, essential for many Indigenous protocols. The detailed design, furnishings, and cultural elements are being developed with guidance from Indigenous Elders, cultural advisors, and artisans.

Inclusive & Accessible

Island Health envisions the new Cowichan District Hospital as a welcoming place of healing and hope, where all people feel safe to receive and provide top quality care. To realize this goal, the project team created an Inclusive Diversity Focus Group whose members provide input and perspective on features that enhance accessibility at the new hospital.

A true first for everyone on the team, discussions with the Inclusive Diversity Focus Group have provided an invaluable source of insights drawn from diverse lived experiences, allowing the project team to adjust the design in real time. Community member Mitch highlighted seemingly mundane things that can make a significant difference for people who are blind or partially sighted, including handrails that extend to the last step of a staircase, sounds, sliding doors, texture changes, and other features that help people get where they need to go.

Holistic Sustainability Approach

As the first fossil fuel-free hospital in BC, the project will incorporate energy saving measures to reduce operational greenhouse gas emissions by 75% compared to the existing facility, despite being three times larger. The project will also be 60% more water efficient and target a 24% reduction in embodied carbon emissions in part by using mass timber and low-carbon concrete in the construction. These ambitious targets—and the innovative strategies being employed to achieve them—are made possible by the Alliance project delivery model, which prioritizes Whole of Life and Environmental Sustainability as one of six Key Result Areas.

Complementing this holistic sustainability approach, the landscape is designed to achieve Salmon Safe certification once complete, including native, adaptive, and drought tolerant plantings that will enhance the natural ecology and provide onsite rainwater management. The project will also preserve as much urban forest canopy and wetlands as possible to protect existing natural habitats.