Ramsey Cottage Hospital needs £4 million of work to tackle what Manx Care calls "critical issues".
It's published the results of a site survey by a specialist UK company which looked at problems at the Cumberland Road facility.
It found serious and urgent problems with doors and windows, roofs, heating, water systems, as well as fire safety.
Manx Care says as well as that, another £2.5 million is needed over the next decade to replace vital equipment such as ventilation, wiring and communications.
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