As World War I ended and the 1920s dawned, Decatur was a booming river town. On the Tennessee River, the steamboats were being slowly replaced by towboats, but cargo transporters continued to ply their goods up and down the channel. The L&N Railroad shop also continued to bring a steady flow of revenue to the area, and the William Keller Memorial Bridge opened up travel to the north, which previously had been accessed by ferry. Decatur's newest restaurant, known as Big Bob Gibson's Bar-B-Q, was thriving, and Malone Livery and Stable had been transformed into a cultural arts center called the Princess Theater.

The blue leather ledger, which remained the hospital's primary admission record until 1936, shows that patients often outnumbered beds, sometimes prompting nurses to give up their sleeping quarters for the sick. So, in 1923 the hospital completed its first major addition by adding 34 beds, as well as x-ray facilities and an operating room.

Though North Alabama suffered through the Great Depression with the rest of the nation, Decatur benefited from New Deal programs that established the Tennessee Valley Authority in 1933, leading to jobs, electricity production, flood, malaria and erosion control, and better river navigation. The area also was fortunate to have a far-sighted Chamber of Commerce, whose members worked to bring new industry: The owner of Alabama Flour Mills, which began producing "Mother's Best" products in 1941, boasted that his company would reduce the cost of flour by a dollar a barrel for local residents, and milk and chicken processing plants helped Morgan County farmers make a living through the lean 1930s and 1940s.

The Benevolent Society Hospital added a second wing in 1938, and the nurse's ward where so many student nurses had lived, was transformed into a patient ward in 1942.

But it seemed as quickly as one bed was added, two more were needed. Hospital officials began to see that keeping up with the community's healthcare needs would take more than local fundraising efforts. Since federal monies were available for public-owned hospitals, but not for private, an effort for Decatur and Morgan County to take over ownership of the hospital was initiated.