The building, designed by Messrs Giles, Gough and Trollope of London followed the compact arrow plan and was built at a cost of £126,000. Originally named the Brecon and Radnor Joint Counties Lunatic Asylum, it was opened amid public ceremony on 18 March 1903, by the Rt. Hon. Lord Glanusk who said of it "everything has been done that human ingenuity could devise for the happiness and safety of the inmates, and under the blessing of God, for their speedy restoration to health."
Like other contemporary institutions, the asylum was designed to be self-sufficient, and had its own private water, electricity, heating and sewerage systems as well as a considerable agricultural estate on which able-bodied patients worked to produce food for the hospital. As well as residential wards, the hospital had a large recreation and dining hall, kitchens, workshops "in which the patients were encouraged to spend their time profitably", a tailor, bakery, shoe-maker and printing shops as well as 8 acres of market gardens.
Initially dedicated to treating patients from the counties of Brecknockshire and Radnorshire, after the First World War, patients from Montgomeryshire were also admitted, and the asylum was extended and renamed the Mid-Wales Counties Mental Hospital.
During the Second World War the hospital took in 67 male and 48 female patients from Cardiff City Mental Hospital which had been requisitioned as a war hospital. In July 1940 it was agreed that most of the hospital should be given over to military use and most of the patients were transferred to other Welsh mental hospitals. The hospital was returned to civilian use in 1947.
In 1948 the hospital became part of the National Health Service. NHS management brought a number of innovations, including art and occupational therapy and the integration of the sexes, who had previously occupied opposite sides of the hospital. The site also became home to the Mid and West Wales College of Nursing and Midwifery and the Powys Drugs & Alcohol Council for substance misuse. Other services included treatments for the elderly mentally ill, rehabilitation and continuing care, day care, reflexology, physiotherapy, electro-convulsive therapy; chiropody and psychiatry.
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