This course will provide perspectives from an owner, architectural and engineering standpoint to describe how a project goes from a clinical need to a finished product when a project is built in an existing, aging facility. Challenges of working in existing facilities will be described that include finding space, displacing current functions, ensuring MEP infrastructure can support the project, and how to build the project in an active facility. Examples of problematic existing conditions that do not meet current code will be reviewed and solutions on how to correct these issues will be described. Future codes will also be presented that would apply to future projects. Owner challenges during construction such as infection control measures and site logistics will be described using examples.