Based on the remains of the Smallpox Hospital in Roosevelt Island (as known as the Renwick Ruin), the Old Hospital is a gutted building with all the upper floors of the building collapsed and crumbling walls; the hospital can be also entered by its open top, making the Old Hospital very unique from other buildings in Liberty City. During singleplayer, some hobos or prostitutes may occasionally spawn. Despite the hospital being abandoned, a first aid kit can be found amongst the ruins.