The National Historic Preservation Act of 1966 and the New York State Historic Preservation Act of 1980 established the National and State Registers programs. The State and National Registers of Historic Places are the official lists of buildings, structures, districts, objects, and sites significant in the history, architecture, archeology, engineering, and culture of New York and the nation. Through Historic Saranac Lake's efforts, over 170 properties have been added to the National Register. Historic districts include:

Name   Description
Berkeley Square Historic District Lying at the center of Saranac Lake's business district, the Berkeley Square District includes Harrietstown Town Hall and twenty-two commercial buildings constructed between 1867 and 1932 on South Main Street and South Broadway
Church Street Historic District The district comprises twenty-seven buildings including three churches, a medical laboratory, ten homes, two libraries, and six Cure Cottages, most built between the late 1870s and 1900; it runs from 57 through 118 Church Street and a short stretch of North Main Street
Cottage Row Historic District The district includes twenty-seven buildings located between 61 Park Avenue and 185 Park Avenue; all are privately-owned, single family houses built between 1900 and 1940, the majority having been built between 1907 and 1917. Most of the residences were operated as commercial private tuberculosis sanatoria.
Helen Hill Historic District   The district includes sixty-two buildings on Helen Hill.
Highland Park Historic District The seventeen buildings of the district, located between 281 Park Avenue and 490 Park Avenue, are private, single-family homes built between 1896 and 1930, with the majority built between 1901 and 1910; it was an expensive enclave, home to millionaires, doctors, and other wealthy families, nearly all with one or more members suffering from tuberculosis.
Trudeau Sanatorium Historic District The first sustained, successful sanatorium for the scientific treatment of tuberculosis in the United States. Thirty-four contributing structures remain, including seven patient cottages, six residences for the medical staff, and six medical facilities.

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