Back in 1956, the 72-room, four-storey boutique hotel at the corner of Burrard and Helmcken was the Burrard Motor Inn—a place where weary travellers could park their Lincoln Continental or Chevy Bel Air and spend a night or two in the big city. But by the 1980s, things had changed: the area around the hotel wasn’t what it used to be, and the inn started to serve a more “by the hour” clientele. Then downtown Vancouver gentrified, and by 2011, so did the hotel; now christened The Burrard and featuring an interior courtyard with palm trees sitting in the six inches of available soil above the building’s 26-car parking lot, it is today a relatively motor-free hotel offering tourists craft cocktails, a communal ping pong table and loaner cruiser bikes.

One constant through it all has been the neighbour across the road: St. Paul’s Hospital. The West End institution has been in its current location since the late 19th century, serving not only the neighbourhood itself, but also the city and province as a centre of excellence for the treatment of heart and kidney disease, nutritional disorders, HIV and AIDS. Some 4,000 people work at the hospital, which takes up almost 300,000 square feet over two city blocks. More than 175,000 patients visit St. Paul’s each year.

For businesses in the area such as The Burrard, St. Paul’s traffic—employees, families of patients, or patients themselves—has made up an important part of their customer base for decades. Darren Simpson, general manager of The Burrard, says “known” St. Paul’s guests—those who identify themselves as patients or family to get the reservation discount—represent only five percent of his total, but he suspects that, because not all hospital-related guests identify themselves, the real share is likely higher. The hotel’s Elysian coffee shop and Burgoo restaurant on street level, for certain, are constantly buzzing with St. Paul’s patrons.

Early last year, the province confirmed that the hospital would be leaving the West End in 2026. While Simpson worries about a potential drop in business, his focus these days is on what comes next. “The larger part of the conversation will come once we find out who buys the property, and what it transitions to be. What I don’t want is another hotel,” he says, glancing up from the courtyard to the imposing outline of the Sheraton Wall Centre behind.

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The oldest remaining part of the St. Paul’s complex is its Burrard Building—built in the Renaissance Revival style in 1912—but the original hospital dates back to 1894, when the Sisters of Providence, a Catholic women’s religious order from Montreal, built a four-storey wood-frame building on a forested plot on Burrard. With only 25 beds, the hospital (built for $28,000) struggled to meet the needs of the rapidly growing city, and over the next few years many more buildings were added to the site. The Burrard Building represented a big leap forward—able to accommodate 200 beds, though at a then-unthinkable cost of $400,000.

The sisters kept a hands-on presence at St. Paul’s until 1969, when the first lay administrator was hired; by 1997, the order had decided there was more power in numbers and merged with other Catholic health-care entities in Vancouver—including the CHARA Health Care Society (which operated Mount Saint Joseph Hospital, Youville Residence and St. Vincent’s Hospital) and Holy Family Hospital Society—to form Providence Health Care, providing health services under the auspices of Vancouver Coastal Health.

Shortly after gaining legal status in 2000, Providence began to explore a new building for its marquee property, St. Paul’s. Additions had been made to the Burrard Building over the years—including two 10-storey towers, in 1983 and 1991—but the hospital couldn’t keep up with the times. By the turn of the century, it was plagued with crumbling edifices, overcrowded hallways and outdated electrical and elevator systems—and was about as far away from “earthquake ready” as it could be.

After more than a decade of heated public debate about whether to rebuild on site or start from scratch elsewhere, in 2015 the Liberal government gave Providence its blessing to pursue a move to Station Street; four years later, the new NDP government (to the surprise of many) approved Providence’s business plan, clearing the last hurdle for a sale. While no price tag has been attached to the sales brochure produced by realtors CBRE, the 6.6-acre site has an assessed value of nearly $800 million. It is, according to CBRE, “Downtown Vancouver’s largest development opportunity in the last 13 years.”

With any redevelopment of this scope, there’s an opportunity to transform a neighbourhood—for better and for worse. Another big hotel across the road wouldn’t be great news for Darren Simpson and The Burrard, but might not be a bad thing for some of the local restaurants and retailers. Does the area need another luxury residential tower, similar to the Wall Centre or The Butterfly, currently rising on the First Baptist site at Burrard and Nelson? And what, if anything, can replace the loss of 4,000 workers?

These are questions that Stephen Regan, executive director of the West End Business Improvement Association, has been thinking a lot about in recent years, ever since the St. Paul’s move became likely.

“It would have been very helpful to know the future of St. Paul’s going into the planning process,” says Regan wistfully, discussing all the work he, along with city planners, put into the 2013 West End Community Plan. “It’s a big job centre, with lots of tentacles and office buildings around the area. Certainly it has contributed to the 24-hour Davie Village vibe. What it gets replaced with is a massive question.”

Given the buzz of activity in Vancouver’s tech community—with monster leasing announcements from Amazon (the former Canada Post building) and Shopify (Four Bentall Centre) in just the past few months—a lot of speculation has focused on what big company might be next, and where it would set up shop. To Regan, a “robust tech/biotech centre could be really interesting” for the St. Paul’s site, but he worries that many of those companies end up creating their own shopping, fitness and eating options within their complex, keeping employees from circulating within the local business community. “They have all these people flowing in, but not flowing out and supporting the neighbourhood. Then you get vacancies, and stretches of commercial streets that suffer.”

Regan admits that it’s “really tricky” to be a curator of the right mix of business, residential and community amenities, but ultimately, he thinks, a balanced solution has to be found. He says that St. Paul’s represents a unique place within the community as a place that attracts visitors to the West End—who spend money on meals, flowers and other goods and services—as well as employees, who spend many hours (and dollars) in area streets.

“I’m pretty sure whatever comes will be a net loss to the neighbourhood,” Regan predicts. “The question is how big that net loss will be, especially in the Davie Village.”

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Just west of the corner of Davie and Burrard, in front of the Fountainhead Pub, stands a 4-by-4-foot heart-shaped neon installation called The Heart of Davie Village, by artist Jim Balakshin. The pub itself, in many West Enders’ eyes, has been the figurative heart of the village ever since it opened 20 years ago: a place where area workers, residents and tourists mingle, play some pool and raise a glass or two. (It’s also a popular stop for campaigning politicians, such as Justin Trudeau in last fall’s federal election, looking for a photo op.)

Michel Duprat, the Fountainhead’s co-founder and co-owner (as well as one of one of four owners of another casual eatery down the road, Mary’s on Davie), has been keeping his eyes trained on what’s happening at the complex across the alleyway. Like Darren Simpson, he worries about the potential loss of business from St. Paul’s—workers coming in after their shift, families grabbing a bite after visiting relatives—but also wonders what redevelopment might herald for the solidly middle-class neighbourhood.

Even before the bulldozers arrive at St. Paul’s, Duprat says he’s already struggling to compete for staff in a hot job market, and even hotter real estate market. “A lot of our staff used to live in the West End or downtown. Now they’re living in Surrey or Coquitlam,” he notes. “They can no longer afford to live downtown.” With employees having to come further and further to work, says Duprat, “it makes it harder and harder to find and keep people.” He’d like the redevelopment to include a mixture of uses, including affordable rental options, “for our workers, and also our customers.”

In the eyes of urban planner Andy Yan—a longtime observer of Vancouver’s development policies—the city’s plans for St. Paul’s, expected within the next few years, could represent a turning point, not just for the West End but also for the city as a whole.

“The West End is an incredible expression of deep urbanism, starting in the 1960s and continuing to the present day,” says Yan, director of SFU’s The City program. “A lot of the workers from St. Paul’s used to live in the neighbourhood—and that’s going to be one of the biggest challenges, moving ahead. When it comes to existing workers—whether it’s janitorial staff or nurses and doctors—where are they going to live?”

Over time, as St. Paul’s workers move closer to the new hospital in East Vancouver, do their West End apartments get renovated, the rents jacked up—and a whole new type of resident moves in? And what does that mean for various Davie Street establishments—pubs like the Fountainhead, or the independent hardware stores and drycleaners who’ve built their businesses on the West End’s current demographic? With any action as ground-shaking as the St. Paul’s move, there are bound to be unintended consequences.

The “alpha” accomplishment of sustainability, Yan argues, is getting people to walk to work: “It isn’t getting them to bike or even take transit, because that means there’s a certain distance.” If we lose that—if more of downtown goes to high-end condos or rentals, occupied by people living or working elsewhere—“we begin to undermine our own ideals of sustainability.” Yan thinks proactive efforts need to be made by the city to shape the community we want to see in 10 or 20 years, one that supports employment opportunities as well as housing close to those jobs. Otherwise, he says, what we’re left with is nothing more than “Coal Harbour South.”

Holly Sovdi, a senior planner with the City of Vancouver, confirms that while Providence “can sell the site to whoever they choose,” the city will be having its say through the development permit process over the next several years. “We can negotiate with the new owner to achieve or maximize the city’s objectives, whether it’s affordable housing, job space or other amenities.”

St. Paul’s represents a unique challenge from a planning perspective. “It’s an opportunity to really do something special, in terms of knitting our city together and being something the city can be proud of,” says Sovdi, who served as lead planner on the West End Community Plan. While it’s too early to speculate on the exact shape of redevelopment, Sovdi allows that the vitality of small business will be of primary concern. “We know that certain land uses contribute more to small businesses,” he says, adding that offices downtown generally contribute about twice per square foot, in terms of dollars spent on local retail sales, as compared to residential. “So when we think about that, we would want to replace St. Paul’s with as much job space as we can.”

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As the debate swirls around them, Providence executives have remained focused on completing the sale of St. Paul’s and stressing the benefits of that sale—specifically, in funding a new state-of-the-art hospital (for an estimated $1.9 billion)—to the general public. “We’re going to sell that land and use that money to build a public hospital,” says Shaf Hussain, vice president of public affairs at Providence Health Care. “That minimizes the cost of construction to the taxpayer—and I think that’s a unique thing in Canada.”

Hussain is very familiar with the arguments against the move. “We’ve been engaging with the community and answering those questions, in various forums, for over 15 years,” he says. “Obviously, the West End had lots of concerns about the hospital moving, but I think we got to a point where they said, ‘Well, yes, a new hospital is needed.’” As for what happens once St. Paul’s vacates the West End, Hussain downplays Providence’s role in that process. “Ultimately, the community will decide. The city has huge rezoning processes that, whoever the proponent is, has to do a ton of consultation. Everybody will have a say in it.”

Someone who has had a lot to say over the years is the West End’s MLA, Spencer Chandra Herbert. He’ss been a vocal opponent of the hospital’s move since taking office in 2008. Despite impassioned lobbying of his NDP caucus mates, though, Chandra Herbert was ultimately unable to change any minds.

“I still wish we could get redevelopment on site. Except I’m the one MLA in 87 who believes that,” he says. “City council voted unanimously to move it to the new site as well. On this one, I’ve paddled upriver a long time.”

With the move a fait accompli, Chandra Herbert says he’ll fight to ensure that “all levels of government remember our neighbourhood, listen to our concerns and involve us with the planning.” He’s hopeful that whatever replaces St. Paul’s will include a significant employer to mitigate the loss of 4,000 jobs, as well as a significant investment in housing. “It’s one of those places where you could put a challenge to developers, the city and province to develop more lower rent, affordable housing. You don’t need to provide parking there, you’re right on a bike lane, and there’s great transit.”

But, he asks, “Will it replace everything? Probably not.”

No matter how balanced the mix of new housing, retail, residential and offices might be for the Burrard site—no matter how sensitive it is to the current and future needs of the demographically diverse West End—few doubt that great upheaval is just around the corner.

“There will be two, three or four years of redevelopment where there will be nothing,” says the BIA’s Regan, who’s looking for an action plan from civic officials to counter the chaos. “There will be dump trucks, there will be disruption and there will be noise. That is going to be shocking to Davie Village. So what’s the plan, City?”