The building has stood as a ruin for decades. Friends of the Ruin works to stabilize the structure, restore its grounds, and find a way for people to experience the building and landscape together.
The organization is volunteer-run and supported by people who believe this unusual place has a future as a public space.

Friends of the Ruin has worked with architects, engineers, preservation specialists, and other consultants to understand the condition of the building and determine what is needed to stabilize it.
This work has included studies of the structure, masonry, site, drainage, and landscape, as well as the preparation of drawings for stabilization.

Since 2017, Friends of the Ruin has worked with students at Williamsburg High School for Architecture and Design. Each year, students study the Smallpox Hospital through drawings, site visits, model making, and presentations.

Friends of the Ruin brings together Roosevelt Island residents, preservation organizations, public agencies, architects, and historians to discuss the building and its future — conversations that shape questions about preservation, public access, and interpretation.
The organization also leads walking tours and other public programs about the Smallpox Hospital, its history, and its place on Roosevelt Island.