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In 1897 the Willesden Board of Guardians acquired a 64 acre site in Acton Lane from the Twyford Abbey estate. They built a new workhouse and infirmary, which opened in 1903, providing accommodation for 400 people, including 150 sick. By 1907 only sick paupers were admitted to both buildings, which were now known as the Willesden Workhouse Infirmary.
The buildings were extended in 1908, 1911 and 1914, when the Infirmary was renamed the Willesden Institution.
In 1921, it became known as the Park Royal Hospital.
In 1930 the Middlesex County Council took over its administrative control and it was renamed yet again in 1931, becoming the Central Middlesex County Hospital, with 689 beds. With even more extensions it had 890 beds by 1939.
During the Second World War, the Hospital was badly damaged by bombs.
When the Hospital joined the National Health Service in 1948, it was grouped together with the Neasden, Kingsbury and Willesden General Hospitals under the North-West Metropolitan Regional Hospital Board.
In 1966 a further building was added for the maternity unit, which had 28 beds but, overall, the number of beds had been reduced to 736, mainly for acute admissions.
In 1997 construction work began on a new building for the Out-Patients Department. The building was named the Ambulatory Care and Diagnostic Centre (ACaD) and opened in 1999. Clinical services transferred from the old buildings to the new, and the second phase of rebuilding began in 2003. The in-patients wing - the Brent Emergency Care and Diagnostic Centre (BECaD) - opened in 2006, with 214 beds.
In November 2008, a private finance initiative (PFI) deal costing more than £80m enabled the Hospital to be rebuilt behind the original buildings.
Most of the old buildings have been demolished (the Out-Patients Department was the first to go) but the Old Refectory remains. The original site is now the foreground to the new buildings and contains a bus station. Some of the material from the demolition was used in the foundations for the new car park and roads.
It had been hoped to preserve the façade of the clock tower but this proved impossible. An old cupola and a flagpole are preserved on the wasteland at the back of the site. Two turrets, the Acton Lane gates, the clock and the foundation stones were saved from demolition. Some of these artefacts are now displayed in the new Hospital grounds.
The remainder of the site will be developed by the Network Housing Group for key worker housing and businesses.