The purpose of this paper it to explore the concept of adding value by real estate and related performance indicators, and the way it is or could be applied in value-based design and management of buildings. The concept is being illustrated with research findings on hospital buildings, based on a literature review and ten interviews with CEOs and real estate project managers. The research findings show that different hospitals prioritize different added values, depending on their overall mission and vision, its position in the real estate life cycle, and the local context. On average, stimulating innovation, improving satisfaction of customers and employees, and supporting (change of) culture rank high, whereas risk management and opportunities to get the real estate costs financed are much less prioritized. A number of added values have been concretized in real estate interventions that are supposed to cause a positive effect on organizational performance, e.g. with regard to patient satisfaction, labor productivity, flexibility and cost reduction. The conceptual framework and research data can be used to support complex decision making in briefing, design and management of hospital buildings and other health facilities. The explorations of adding value by real estate might be applicable in other sectors as well.