The Weston State Hospital housed West Virginians with mental health issues from 1864 to 1994. Built on 269 acres across the West Fork River from Weston, it was authorized by the Virginia legislature in the early 1850s as the Trans-Allegheny Lunatic Asylum. Politics may have been the overriding reason in choosing its site; Lewis County, a Democratic island in a sea of Western Virginia Whigs, exercised considerable influence in Richmond.

The hospital's huge main building, two-tenths of a mile long, was designed by Richard S. Andrews of Baltimore, whose other work includes the south wing of the U.S. Treasury Building in Washington and the Maryland governor's mansion. A committee toured similar institutions in several states to determine what features were required. The General Assembly appropriated $50,000, and construction was under way by the end of 1858.

The Civil War interrupted the work. Virginia's Confederate government demanded unused funds be returned for state defense, but the money was saved by sending it to Wheeling. In 1862, the pro-Northern Reorganized Government of Virginia added $40,000. Work resumed and continued through the rest of the war. In 1863, the name was changed to West Virginia Hospital for the Insane, and Dr. James A. Hall was appointed its first superintendent. He was replaced by Dr. R. Hills, formerly of Columbus, Ohio, just as the first patients entered on October 22, 1864.

By 1868, 200 patients were being cared for at the hospital. The legislature voted $110,000 in 1870 for additional buildings, and separate rooms for Black patients were added in 1873. The hospital had its own farm, dairy, waterworks, and cemetery. Ultimately, it grew to house about 1,200 patients. In 1913, the West Virginia legislature changed the name of the hospital to Weston State Hospital.

On October 3, 1935, a patient started a fire in the main building that destroyed six men's wards and caused a cupola to fall through the roof. Governor Herman Guy Kump, attending the Forest Festival in Elkins, rushed to the scene. The building was repaired and the hospital remained in service for nearly 60 more years. From 1952 to 1955, numerous patients were lobotomized as part of the West Virginia Lobotomy Project. In 1978, the main building was listed on the National Register of Historic Places, and in 1990 it was named a National Historic Landmark.

Weston State Hospital closed in May 1994, replaced by the new $27 million William R. Sharpe Jr. Hospital in Weston. The Weston State Hospital building, now privately owned, is operated as a tourist attraction under its original name, the Trans-Allegheny Lunatic Asylum.

Read the National Historic Landmark nomination