Emperor Paul I built the hospital, having vowed during a serious illness to create a free clinic for the poor after his recovery. To commemorate the reason for the founding of Pavlov Hospital, a medal was minted featuring Paul I and the inscription: "Having freed himself from illness, he thinks of the sick." Initially, the building was wooden, but after a fire in 1784, Paul decided to rebuild it in stone. The project was developed by V.I. Bazhenov, however, the construction of the hospital was completed in 1802-1807 according to M. Kazakov's design. The official reason for the delay was cited as a lack of funds, but this coincided with Bazhenov's work on Tsaritsyno and his subsequent dismissal, which may have led to the project being handed over to Kazakov.

The hospital building resembled a three-story palace with the Church of Apostle Paul in the center. During construction, the overseer Troyankin embezzled state funds, and in 1811, the court prohibited Kazakov from engaging in state projects. Thus, the main building of the hospital became the last work of the architect. In the 1830s, Pavlov Hospital was reconstructed according to D. Zhilyardi's design. At that time, the gates were adorned with lions, wings for the pharmacy and laundry were added, as well as additional buildings and a facade in the classical style. Notable doctors such as F.P. Gaaz, F.A. Rein, I.F. Erasmus, and E.I. Martsinovsky worked at Pavlov Hospital. Today, it continues to operate under the name of the 4th City Clinical Hospital. The medical center occupies 30 buildings of varying heights on a territory of 13 hectares.