By Rebecca Casey and Jessica King, Contributing Writers

Across the country, thousands of empty big-box stores sit idle, dormant shells of retail’s past. But within these abandoned structures lies an untapped opportunity: a framework for delivering modern healthcare. 

With more than 650 million square feet of vacant retail space in the United States as of late 2024, developers, healthcare systems and architects are asking an important question: How can we give these buildings a second life and bring essential services closer to the communities that need them most? 

Adaptive reuse of big-box retail is becoming an increasingly popular strategy for expanding access to healthcare in urban and suburban settings. These projects often offer shorter development timelines than new construction, allowing for the rapid introduction of vital outpatient services. They also align with sustainability goals by preserving embodied carbon and reducing the environmental impact of demolition and reconstruction. 

Beyond the environmental and logistical advantages, repurposing former stores brings care directly into familiar, accessible spaces with ample parking and visibility, features that enhance convenience for patients and staff. 

Flexible space, efficient flow, intuitive wayfinding 

Repurposed big-box stores offer expansive floorplates and high ceilings, giving healthcare designers the flexibility to create environments that are operationally efficient and emotionally supportive. Open layouts allow clinical teams to tailor workflows, reduce patient stress and enhance staff collaboration through clear zoning and modular pods. 

These generous spaces also support diverse ceiling heights that improve acoustics, privacy and comfort. Intuitive wayfinding can be embedded into the architecture, minimizing reliance on signage through the use of strategic color accents, local artwork, branding, lighting cues and material transitions. Visual anchors, such as sculpture and architectural features, guide movement, while volunteers and staff offer added support. Together, these layered design strategies transform blank-slate interiors into welcoming, high-performance healthcare environments. 

Natural light and sustainability 

Most retail stores were not designed with wellness in mind. They often have deep footprints and minimal windows, creating interior environments that feel dark and cavernous. 

In healthcare spaces, daylight is more than a design preference. It contributes to patient healing and staff wellbeing. Designers are creatively addressing this challenge by integrating skylights, clerestory windows and interior courtyards and using strategic glazing and lighting strategies — all of which contribute to a more inviting, health-promoting atmosphere. 

Adaptive reuse is inherently sustainable. Besides reducing construction waste and embodied carbon, reused big-box structures can incorporate sustainable technologies such as solar panels, rainwater collection systems and green roofs. These upgrades can also reduce operational costs and align the facility with broader organizational climate goals. 

Smart growth in action 

Transforming a former retail mall into a modern healthcare facility aligns with the core principles of smart growth, including revitalizing underused properties, promoting more efficient land use and meeting community needs without expanding the built footprint, particularly when mixing uses in redevelopment. 

By concentrating healthcare services in an existing commercial corridor with access to major roads and public transportation, the project reduces development pressure on surrounding greenfields while improving access to care. This approach minimizes environmental impact, strengthens the local economy and reactivates a familiar community space with a new, future-focused purpose. 

But not all big-box buildings are ready for transformation without scrutiny. A careful feasibility study is essential before purchasing or leasing. 

What to know before you convert 

Before undertaking a retail-to-healthcare conversion, owners and developers should thoroughly evaluate the building’s condition and capabilities. Key areas of focus include: 

Building envelope. Many older stores were built to comply with outdated energy codes. Upgrading insulation and glazing can significantly lower energy use and improve occupant comfort. 

Roof condition and load capacity. Assess the roof for leaks, age and structural capacity, especially if additional HVAC equipment or rooftop solar is planned. 

Floor slab compatibility. Healthcare environments require substantial plumbing and sanitary infrastructure. Structural slabs might not allow for the trenching needed to install these systems. Creative workarounds are possible but add cost and complexity. 

Ceiling heights and infrastructure need. Mechanical systems often require mezzanine or rooftop space. Verify clearances and load capacity early to avoid surprises during the design process. 

Case Study: Saratoga Hospital at Wilton Mall 

In Saratoga Springs, New York, a former Sears department store is now home to an outpatient primary and specialty care clinic. With a strategic layout and community-forward vision, the project has revitalized part of a declining mall into a center for health. 

The open-plan space enabled the design of collaborative care pods, where clinicians can simultaneously see and support multiple exam rooms. By optimizing the layout, the design team reduced initial square footage while preserving room for future expansion — a win for both budget and long-term flexibility. 

Rather than cutting new skylights, the team introduced high perimeter windows to usher daylight deep into the space. This daylighting approach supports patient experience and staff wellbeing. Meanwhile, the healthcare center anchors a broader redevelopment vision for the site, laying the groundwork for a mixed-use district that restores economic and social vitality to the area. 

Case Study: From big box to specialty clinic and surgery center 

Another recent conversion project transformed a former Burlington Coat Factory store into a specialty clinic and ambulatory surgery center. The design leveraged the existing building’s deep façade to create two distinct, branded entrances — one for outpatient care and the other for surgical services. 

A critical design feature was the pedestrian-focused arrival zone. The team modified adjacent vehicle circulation patterns to create a safe, walkable entry plaza with a covered drop-off, improving access for patients and caregivers. 

To address the needs of patients with visual impairments, designers enhanced wayfinding using large-scale graphics, color-coded pathways, architectural elements and directional lighting. Interior planning prioritized clear circulation and distinct zones that minimized noise and maximized privacy. 

Though the design avoided cutting into the roof, the team simulated daylight using acoustic baffles and LED fixtures that mimic natural lighting. An underused loading dock was enclosed to create a glassed-in porch at the staff lounge, offering views of the surrounding wooded landscape and a quiet space to recharge. 

Reimagining retail as healthcare is not just a trend. It’s a long-term strategy for expanding access, revitalizing communities and reducing environmental impact. The transformation of underused big-box spaces into modern healthcare facilities offers a flexible and cost-effective path forward in a time when healthcare demand continues to rise and construction costs remain high. 

These projects demonstrate the way thoughtful design, combined with strategic assessment, can breathe new life into old structures, enabling healthcare organizations to meet patients where they are, literally and figuratively. 

Rebecca Casey, AIA, Well AP, is principal with SMRT Architects & Engineers. Jessica King, NCIDQ, LEED AP ID+C, is senior interior designer with the firm.