Second Chances: Reimagining Big-Box Retail as Healthcare Hubs

The story of architecture is one of continuous evolution, where second chances breathe new life into spaces that have lost their original purpose. In today’s context, few building types are more emblematic of this opportunity than big-box stores. As of Q4 2024, the retail vacancy rate in the United States was 5.4% (Cushman & Wakefield Marketbeat United States- Retail Q4 2024). This excess retail space equates to approximately 650 million square feet and the loss of tenants leaves many communities with hulking reminders of shifting consumer habits and retail trends.

The transformation of big-box stores into healthcare facilities is redefining how communities access medical care. These once-vacant retail spaces offer a unique opportunity to bring essential health services closer to patients, often in highly visible, easily accessible locations with ample parking. Repurposing these structures often allows for faster project completion than new construction, meaning communities can benefit from much-needed care sooner. Additionally, adaptive reuse supports sustainability by reducing environmental impact and preserving embodied carbon. By converting these spaces into modern healthcare environments, providers can enhance patient convenience, improve public health access, and support smart growth strategies by revitalizing underutilized properties into thriving community assets.

Designing Healthcare Spaces in Big-Box Stores

Retail buildings are known for their expansive, open floor plans and high ceilings. Executing a thoughtful design process, we can imagine how these spaces might be reconfigured to provide patient-centered care.

1. Maximizing Natural Light
   Big-box stores typically have few windows, resulting in dim, uninspiring interiors. By incorporating skylights, interior courtyards, or strategically placed windows, designers can flood these spaces with natural light, creating a welcoming and healing environment for patients.
   
   
2. Inherently Flexible Space
   Healthcare environments thrive on efficiency, clarity, and adaptability. By dividing big-box floorplans into multifunctional zones with clear and intuitive pathways, we provide patients and staff with smooth access from waiting areas to treatment rooms. Retail mall footprints allow for flexible layouts that accommodate a variety of healthcare needs, from primary care clinics to specialized treatment centers. Ample volume enables higher ceilings, contributing to a sense of openness and a more comfortable patient experience. Additionally, high floor-to-structure volume may offer opportunities for mechanical and electrical mezzanine space.
   
   
3. Sustainable Interventions
   Sustainability is at the heart of adaptive reuse. Beyond preserving embodied carbon, big-box stores can be equipped with photovoltaic panels, rainwater collection systems, and green roofs, aligning healthcare facilities with broader environmental goals. These conversions also offer a way to reintegrate underutilized properties into the community fabric, supporting smart growth strategies.

Vacant retail spaces across the country sit in aging buildings that no longer meet modern codes. For this reason, it’s important to engage design professionals for a feasibility study before embarking on a conversion project. Uncovering hidden or phantom costs associated with existing conditions will help you plan for the type of renovation investment the project will require.

Consider the following before leasing or purchasing retail space:

1. Calculate the insulation value of the building envelope: It is highly likely the building was constructed to code minimums, codes which have since been updated. Consider upgrading the building envelope’s insulation to lower the energy use intensity and control operating costs associated with heating and cooling.
   
   
2. Assess the core and shell condition: Make sure you understand the structural capacity and condition of the roof by evaluating its ability to support additional HVAC equipment and determining whether additional insulation can be added, which could increase snow loads. You should also assess opportunities for adding skylights, review the roof’s replacement history, and check for any evidence of leaks.
   
   
3. Determine the condition and type of floor slab: Structural slabs can pose problems for healthcare facilities that require substantially more plumbing and sanitary lines than retail spaces. While standard slabs can be sawcut to accommodate lines, structural slabs cannot. There are ways to work around this limitation, but they come with added complexity. Also, floor slabs may not include the necessary vapor barriers for the installation of sheet flooring products preferred by many healthcare facilities.
   
   
4. Confirm the floor-to-structure height: It may appear at first glance the facility has ample structural height to accommodate infrastructure systems on an interior mezzanine, the reality is many are just shy of the necessary space to do so. If your roof cannot support roof-mounted systems, you may need to devote valuable interior space to air handlers and other mechanical and electrical systems by reducing the square footage available for occupied space.
   
   

Case Study: Saratoga Hospital Wilton Mall Primary Care

The Saratoga Hospital Wilton Mall healthcare facility in Saratoga Springs, New York is a shining example of reimagining underutilized retail space for outpatient care. Housed within a former Sears department store, this adaptive reuse project has become a vital healthcare hub with primary care and specialty care services. The project exemplifies the potential of big-box conversions:

• Efficient Use of Space: The large open plan supported the design of collaborative clinical hubs with clear views of every exam room. A data-driven approach optimized the layout and enabled the practice to build a smaller footprint on day one, leaving additional space for future growth and reducing first cost.
  
  
• Creative solution for daylight: Without adding skylights to the roof, the project incorporates high windows bringing daylight well into the collaborative care hubs and supports staff wellness.
  
  
• Flexibility: The flexibility of an open plan allowed for open clinical hubs/pods to support collaborative care and visual management. In addition, flexibility enabled clear pathways to enhance patient flow, addressing common frustrations in healthcare settings.
  
  
• Smart Growth: The project supports smart growth and reinforces the hospital’s commitment to supporting the community with convenient care. It does so by reinvigorating an aging mall as part of a larger vision to redevelop the site into a mixed-use community. Additionally, by reusing the structure, the project minimized environmental impacts and construction costs.

Case Study: Confidential Client – Specialty Clinic and Surgery Center

This design for a confidential client is another example of the extraordinary potential of adaptive reuse in healthcare. Located in a former Burlington Coat Factory store, this transformation turns an underutilized retail space into a state-of-the-art eye care practice and ambulatory surgery center. The project highlights key benefits of big-box conversions:

• Optimized patient arrival: Working within the existing shopping plaza layout, the project reconfigures nearby traffic lanes to create a pedestrian-friendly crossing zone with a covered drop-off area and a one-way bypass lane. The design takes advantage of a long façade by creating dedicated entrances and arrivals for both the clinic and the ASC, supported by a renewed façade, branding, and signage.
  
  
• Wayfinding: Recognizing the needs of patients with visual impairments, wayfinding is designed with clear, intuitive routes marked by graphics, floor patterns, architectural forms, and lighting features that serve as visual landmarks—guiding patients seamlessly through the space. Additionally, the high ceilings will allow for a variety of spatial volumes that naturally separate quiet and active areas, enhancing sound privacy and creating spatial hierarchy.
  
  
• Enhancing the staff experience through creative design: Rather than modifying the roof to add skylights—which was reinforced instead to support a full solar array—the design incorporates skylight-inspired lighting fixtures with acoustic baffles in staff work areas. These elements mimic natural daylight while reducing noise in busy work hubs. A former loading dock has been enclosed to create a glass-walled porch adjacent to the staff break area, offering a relaxing retreat with views of the wooded landscape beyond.

This innovative reuse demonstrates how retail spaces can be reimagined as modern healthcare environments.

A New Purpose for Old Structures

The adaptive reuse of vacant, big-box stores for outpatient care is a strategic, sustainable, and community-driven solution to the challenges facing healthcare providers. It’s also an opportunity to leverage the inherent advantages of these structures—accessibility, open floor plans, and large footprints—to create patient-centered environments that improve public health access while revitalizing underutilized properties. Case studies like Saratoga Hospital Wilton Mall and Eyecare Medical Group illustrate the vast potential of this transformation, demonstrating how thoughtful design can turn aging retail spaces into thriving, functional healthcare hubs. As communities continue to seek innovative solutions for healthcare delivery, repurposing big-box stores stands as a compelling model for smart growth, sustainability, and the reinvention of the built environment.