The main asylum building has enough rooms to support holding a minimum of 500 patients. To be entered into the asylum requires an order signed by the Superintendent of the Poor of the County and two certificates of "insanity" from medical examiners. The asylum accepts both men and women, with separate buildings for each, and all admitted patients arrive by boat.

Patients who are deemed to be "mentally stable" are encouraged to be involved in labor at the facility, from the sewing shop, to gardening and farming. The campus will expand into several more buildings over the next several years, including women's and men's infirmaries and a cemetery on Seneca Lake, sprawling over 929 acres of land by 1885. The Willard Asylum will become the Willard State Hospital when the State Care Act, of Chapter 126, [NYS] Law is passed in 1890.