When it first opened treatment was received by payment only: admissions were only taken at 11 o'clock every morning (except Sundays) and if you hadn't paid your one guinea a year subscription to the hospital (a kind of insurance to ensure treatment when it was needed) you were charged sixpence on admission and were then required to pay a further guinea for further treatment. If you were too poor to pay these fees, you went to the workhouse located on Bierton Hill (now the Tindal Centre).
The current building dating from 1862 replaced an earlier building on the site. The design was influenced by Florence Nightingale who had recently returned from the Crimea and was the first pavilion style civilian hospital to be completed in the UK. Letters and sketches by her about the design are in the Bucks County Council Reference Library.
Florence Nightingale also did a lot of fundraising for the hospital, keeping the admission fees low, ensuring the hospital was able to treat more people.
Originally called the Buckinghamshire Infirmary, it is thought that it became "Royal" after the future Edward VII received treatment there after breaking a limb during a visit to the Rothschilds at Waddesdon Manor.
It was the main hospital for the town of Aylesbury all the way through to 1948 when Stoke Mandeville Hospital on the outskirts of town was expanded and took over that role. From that time it became a maternity hospital until the early 1990s when a new maternity wing was opened at Stoke Mandeville.
The Royal Bucks, as it had become known, stood empty for a few years, before being renovated and turned into a private hospital for the treatment of spinal injuries. It is for this purpose that the hospital is used today.