Caithness General Hospital is owned and managed by the National Health Service (NHS Highland) in Scotland. NHS Highland is the largest Health Board in Scotland. In 2019, Caithness General was the first hospital in the world, and the first public sector organisation in the world, to achieve Alliance for Water Stewardship (AWS) certification. This case study demonstrates the relevance of water stewardship to public sector organisations - particularly hospitals and other health facilities. The presence of pharmaceutical residues in water is recognised internationally as an important public health and environmental issue. The quality of the used water discharged from Caithness General into the sewerage system, and from there into the environment, was a key focus of the implementation of the AWS Standard at Caithness General, alongside improvement of efficiency of water use within the hospital.