The first mention of the Spaso-Transfiguration Monastery appears in the Novgorod First Chronicle for the year 1192: "In that same year in Rusa, a church was built on the island, by the abbot Martiry, in the name of the holy Transfiguration, and a monastery was established, which became a refuge for peasants and Christians." This record is the first among regular chronicle testimonies about Old Rusa, although earlier, in 1167, Rusa was already mentioned in the chronicle. The record states that the monastery was founded "on an island," although the area where the monastery is located is not an island now. Pre-revolutionary descriptions of the monastery suggest that the Voye stream, which flows around the city from the east and empties into the Polist River behind the monastery, formed an island in the past. In 1194, the monastery burned down along with other buildings in Rusa. In 1198, its founder, who became an archbishop, Martiry, built a stone cathedral there.

The original appearance of the Spaso-Transfiguration Cathedral has not survived, and it can now only be imagined based on archaeological research. According to them, the temple was typical of Novgorod architecture of that time: almost square, with four pillars, three entrances, and a three-part division of the walls. It resembled the churches of Spas on Nereditsa and Peter and Paul on Silnitsa, but was distinguished by a stair tower at the northwestern corner, which was rare for Novgorod churches of the late 12th century.

By the mid-15th century, the cathedral had fallen into disrepair, and in 1442, under the abbot Ioann, it was rebuilt, almost completely dismantling the old walls. The initiator of the reconstruction was the Novgorod bishop Euphemius II, who consecrated the temple after the construction was completed. The cathedral acquired a three-part covering, characteristic of Novgorod churches of that time, and became two-storied. It remained in this form until the 17th century. During the Time of Troubles, when Old Rusa was occupied by Swedish troops, the monastery was ravaged, and the surrounding yards were burned.

Subsequently, the cathedral was used as a grain warehouse and by the beginning of the war was in a deplorable state. During the occupation, the surviving buildings housed a German commandant's office. In the 1960s, restoration of the architectural ensemble began in preparation for the 800th anniversary of Old Rusa. The windows of the lower tier were restored in the style of the 15th century, and one window of the second tier was also restored on the southern facade. On the southern facade, two frames with "broken" pediments, characteristic of Novgorod architecture of the late 17th century, have survived. During the restoration of the altar apses, their unevenness, lost in the 19th century, was revealed. The window openings and the decor above them date back to the 15th century. The upper part of the building was completely rebuilt in the first third of the 17th century, which is reflected in the decor of the drum.

Now the cathedral has been turned into a museum and is devoid of liturgical functions. It houses a local history exhibition, but its constructive features revealed during the restoration remain visible. For example, the eastern pillars of varying cross-section, round at the bottom and square at the top, have survived since the 15th century. The cathedral was painted in the 15th and 17th centuries, but only small fragments of frescoes, testifying to the skill of ancient artists, have survived to this day. They are located on the eastern pillars, previously hidden by the iconostasis, and in hard-to-reach areas of the walls, as well as on the western wall and in the niches-arch consoles.