In March 1862, the Exchange Hotel was taken over by the Confederate Army and received the Confederate and Union wounded, from the battlefields surrounding Orange County, for the duration of the war. During the Civil War, the Exchange Hotel became known as the Gordonsville Receiving Hospital.
Dr. B.M Lebby of South Carolina was the director and its operation continued under his leadership until October 1865.
The wounded and the dying came from nearby battlefields such as Cedar Mountain, Chancellorsville, Trevilian Station, Mine Run, Brandy Station, and the Wilderness were brought by the trainloads. Although the hospital was primarily a Confederate facility, the hospital treated the wounded from both sides. Twenty-six Union soldiers died here.
By the end of the U.S. Civil War, more than 70,000 men had been treated at the Gordonsville Receiving Hospital and just over 700 would be buried on its surrounding grounds and later interred at Maplewood Cemetery in Gordonsville.
In present day the former Gordonsville hotel and hospital serves as the Exchange Hotel Museum. The museum details the medical history of the U.S. Civil War.