Health care is changing rapidly. Hospitals are, and will remain, an essential setting to deliver it. We discuss how to maximise the benefits of hospitals in the future in different geographic and health system settings, highlighting a series of cross-cutting issues. We do this by exploring the evolving roles of hospitals and the main factors that we must consider as they adapt. These include changing population and disease profiles, the impact of evolving technology, and new concepts in hospital design and planning. Our focus is on delivering high-quality, patient-centred care while ensuring equitable access, even if strategic decisions require compromise across these functions. The COVID-19 pandemic has shown the importance of hospitals in societies while also revealing the limitations of current structures and the potential of technology to transform hospital services within the broader healthcare system. The aim of this multidisciplinary perspective is to provide an overview of pertinent issues whilst highlighting the challenges and opportunities in optimising future hospital planning, construction, design, and development in high-income (HIC) and low -and medium-income country (LMIC) settings.