This article examines the extent and nature of hospital and almshouse provision in early modern Scotland. It suggests that in order to understand early modern poor relief more fully, more attention needs to be paid to the variety of possible sources of welfare, not all necessarily associated with Poor Laws and compulsory or statutory provision. Hospital provision was an important component of welfare, and indeed was closely related to the wider apparatus of relief. The article argues in particular that the Protestant Reformation of 1560 was an important factor in improving both the provision of funding for hospitals, and the effectiveness of their administration. Although it initially posed a potential threat to the network of late-medieval hospitals and caused some disruption, the Reformation’s creation of a network of local church courts, and in particular the kirk session, was crucial to the operation of both surviving pre-Reformation hospitals and the new foundations which emerged in the late sixteenth and seventeenth centuries. The article also assesses the limitations of the church’s achievements, and notes that rural areas enjoyed much less secure hospital provision. Finally, the article offers a case-study of life in Glasgow hospitals, moving beyond the institutional mechanisms involved in hospital fundraising and administration to explore the experiences of inmates themselves. Future studies of early modern poverty will need to take much greater account of hospitals’ role in the ecology of relief, and of the church’s ongoing role in welfare provision, narratives of secularisation notwithstanding.