Since 1962, the Holy Makariy Church has served as the cathedral of the Poltava Diocese. In the early 20th century, no one could have imagined that a small parish church on the outskirts, known as Berekovka or Holodrabovka, would become the main cathedral.

The main benefactor of the church's construction was the Poltava merchant of the second guild, L.V. Kolesnikov. Lev Vasilyevich and his wife Anastasia Ivanovna left a good memory, captured in the churches of Poltava. It is known that their funds were used to build and maintain the Holy Trinity Church in Sennaya Square, where they were buried. The family bequeathed significant funds for the construction of the Makariy Church, which was built in 1903, two years after Kolesnikov's death. In 1904, the church was consecrated by the Bishop of Poltava and Pereyaslav, Hilarion, in honor of the Holy Martyr Makariy, the miracle worker of Pereyaslav, Ovruch, and Kaniv.

In 1907, another chapel was consecrated in the church in honor of the prophet Elijah. This is evidenced by a cross with an inscription, installed on a simple wooden altar: “In the name of the Father, and of the Son, and of the Holy Spirit. This Holy Altar was constructed in honor and memory of the Holy Prophet Elijah during the reign of Emperor Nicholas II, under Bishop Ioann, at the expense of parishioner Ilya Konstantinovich and his wife Agafya Isidorovna Radchenkova. This Holy Altar was consecrated with the blessing of the Bishop of Poltava, city dean, Archpriest Vasily Glinsky on May 12, 1907, with the rector of the church, Priest Ilya Feodorovich Kushchinsky, Deacon Vasily Zaporozhchenko, and church elder Mikhail Andreevich Shpilka. Citizens Anna Petrovna Morguleva, Anna Kononovna Testenkova.”

In the 1930s, the Makariy Church continued to operate. On Great Friday in 1937, Hieromonk Efrem served during the procession of the Holy Shroud and was preparing to meet Great Saturday, but was arrested. As a result, Poltava welcomed the Easter celebrations in silence. For the first time in the city's history, the bells were silent, kulichs were not consecrated, and parishioners sadly returned home. The authorities did not seize the church but hypocritically stated: find a priest and serve. The keys to the church remained with the elder. Later, a priest from Kharkiv was appointed, who served for about a month. Then the church fell silent again. In 1938, on Epiphany, the bells rang, but only for a short time, just a month. Later, the church was used as a storage for sugar, but this did not damage it, as the bags lay on the floor, and the altar remained untouched.

In September 1941, after the Germans occupied Poltava, leaflets were distributed announcing freedom of religion. On October 14, on the feast of the Protection of the Mother of God, the first long-awaited service took place after almost two years of interruption.

After the demolition of the Transfiguration Cathedral in 1962, the Makariy Church received the status of a cathedral. Several restorations did not change its original appearance.