Adaptive Reuse: Malls to Mixed-Use, Medical, and More

By: Kevin Paul, AIA, NCARB, LEED AP, CFM | Senior Vice President & Director of Private Sector Architecture

For more than 50 years, shopping malls dominated the American retail landscape. The Southdale Center, commonly recognized as the nation’s first shopping mall, opened in Edina, Minnesota, in 1956. In the decades that followed, malls took on a major role as informal social and commercial hubs for suburban communities across the country. By the 1980s, the United States was home to roughly 2,500 shopping malls. However, this cultural and economic dominance began to wane in the early 2000s as consumers increasingly embraced the convenience of online retail, also known as e-commerce.

Traditional brick-and-mortar stores faced additional strain during the COVID-19 pandemic, which made in-person shopping less safe and further encouraged consumers to rely on e-commerce for a wider range of products and services. By the end of 2022 — the pandemic’s social impacts having exacerbated the long, steady decline in mall attendance — the number of malls in the United States had fallen by nearly 72 percent compared to its peak decades earlier.

Though the downturn in mall attendance over the last few decades represents a bittersweet end to a significant era in retail, there are also tremendous opportunities to convert these bygone community hubs into new uses more aligned with the needs of today’s residents. In places like Florida — home to more shopping malls than nearly every other state in the U.S. — transforming underused malls should be an integral component of any economic development strategy.

Benefits of Adaptive Reuse

Adaptive reuse is a technique that repurposes old, underutilized structures for new, modern uses. Compared to traditional construction, adaptive reuse requires fewer new building materials and generally produces less air, ground, and water pollution due to a reduction in both the amount of equipment required for demolition and the environmental hazards that often accompany the demolition process.

Furthermore, adaptive reuse expands opportunities for new commercial real estate in communities without an abundance of open land to develop. Abandoned factories can become healthy grocery stores in food desert communities. Unused church buildings can transform into lively learning centers. Struggling shopping malls, meanwhile, can take on any number of vibrant new uses, from housing to healthcare and beyond.

Malls to Mixed-Use

Mixed-use developments incorporate a blend of land uses, usually pairing residential housing with shops, restaurants, event venues, healthcare clinics, and more. Much like how malls aim to create community hubs centered around shopping and recreation, the goal of mixed-use developments is to create pedestrian-friendly environments by locating retail, office, and other uses within the same development as housing.

Malls are ideal sites for mixed-use developments due to their massive square footage and the presence of existing amenities. Their large building footprints can accommodate dense multifamily housing, while spacious lots provide ample parking for residents and guests; these factors can assuage community concerns about traffic and overcrowding while also helping developers meet off-street parking minimums often required by municipalities.

Mall courtyards and other open areas can be transformed into community spaces such as fitness centers, parks, and communal lounges. The mall’s existing shops, restaurants, and event venues can also fulfill the retail needs of the development, as they already possess the infrastructure to support new businesses.

Malls to Medical

As healthcare spending in the U.S. increases, particularly among the rapidly growing senior citizen population, so too has the demand increased for outpatient medical facilities such as urgent care clinics, testing laboratories, and surgical centers. Through adaptive reuse, malls have the potential to become comprehensive medical hubs that offer patients more flexibility and convenience compared to traditional hospitals.

Depending on location, malls may be subject to zoning that also allows for medical uses, which can help developers avoid many of the re-zoning headaches that can come with new construction. Similarly to housing, abundant parking options are ideal for both visitors and developers looking to meet parking minimums; likewise, malls feature existing on-site stormwater systems that are often sufficient to fulfill the specific drainage requirements of healthcare facilities.

Medical suites often have very specific cooling and heating needs dependent on the patient services they provide and the equipment they use. The existing HVAC systems in malls can be adapted to fit the specific requirements of each individual medical space. Healthcare facilities also require significant power, particularly if redundancies in the electrical systems are required for consistent operation; malls are more likely to have the required capacity to meet the heightened demands.

One recent example of the successful conversion of a shopping mall into a medical facility is Stony Brook Medicine’s Advanced Specialty Care facility at the Smith Haven Mall in Lake Grove, NY. H2M repurposed a 170,000-square-foot former Sears space, transforming it into a hub that centralizes various medical specialties under one roof in a seamless blend of medical expertise and retail convenience. The adaptive reuse work incorporated designs for new mechanical, plumbing, and electrical systems, including a cost-effective rooftop HVAC system capable of maintaining the unique temperature and air quality needs of each zone of the facility.

Other additions included a rooftop generator and streamlined plumbing systems to ensure the facility can remain operational at all times. By implementing these new systems within the existing infrastructure, the developer was also able to save money on overall project costs.

Additional Considerations

Adaptive reuse is not a one-size-fits-all process. How much of a mall can be repurposed is dependent on a wide variety of factors, including the quality of the mall building’s structure and internal systems, the developer’s intended new use for the building, and the location of the mall site. The best uses will vary depending on the demographic composition of the local population, the needs of the community, and any potential constraints placed by local government.

Developers should work hand-in-hand with an experienced consultant who can help identify the most appropriate uses for a given property, navigate municipal and community approval, and develop designs for thoughtful, sustainable adaptive reuse that conforms to both local regulations and the needs of residents.

As developers aim to meet increased demands for residential, commercial, and industrial real estate, it is vital to examine our nation’s stock of shopping malls and decide whether they better serve their communities as monuments of a bygone era or as the key to a brighter future.