Adaptive re-use of old buildings is “as old as the hills” and many of our oldest schools were converted from residences. Since World War II in Barbados, however, old buildings. including many historic treasures, were regarded as unfashionable, allowed to decay and have been demolished. Preservation of historic buildings only succeeds if viable adaptive re-use can be achieved. This is the secret of our successes. While the Barbados National Trust and this author individually have reaped some remarkable successes, there are many challenges. Henry Fraser is retired Dean of the Faculty of Medical Sciences and Founding Director of the Chronic Disease Research Centre of the UWI, Cave Hill Campus in Barbados.