As a scribe wrote—repeatedly, and perhaps less than idly—in the margin of the Heilig Geist Spital's account book: non bene pro toto libertas venditur auro, liberty is not well sold at any price. The conscientious recordkeeping of Mainz's hospitals indicates that they managed their resources in the service of the sick, and most jealously guarded the economic liberties afforded them by their legal status. As institutions governed by religious rules, though not part of religious orders, independent hospitals enjoyed both the privileges and responsibilities of religious status. As religious institutions, they received donations from their neighbors, indulgences from ecclesiastical officials, and, sometimes, opposition from civic officials. The precise implications of religious status for hospitals were not always clear. Like other religious institutions, they sometimes defended their prerogatives against civic officials; sometimes negotiated their rights in relationship to diocesan authority; and sometimes entered into conflict with lay and parish interests. Such moments of conflict, however, were not the result of legal ambiguity attached to hospitals in particular. Rather, they parallel similar episodes in the institutional histories of monasteries. As hospitals grew in and alongside prosperous cities in the later Middle Ages, debates on their function, location, and regulation were not uncommon. These debates were not the result of a legal vacuum, but of the range of possible meanings attached to religious status in the later Middle Ages.

Analyzing independent hospitals in light of the evolution of canon law makes it possible to identify patterns in their institutional development. Conciliar legislation and local charters alike bear witness to attempts to define both the legal parameters and the practical implications of religious status. To argue that hospitals were places of care rather than religious institutions is to construct a false dichotomy. Rather, providing care for Christ's sick-poor was constructed in legal as well as social terms as the core mission of the men and women who took vows in hospitals, the houses of God.

The diversity of vocabulary applied to hospitals has sometimes, paradoxically, led to their invisibility in the historiography of religious institutions. But medieval hospitals were not just hospitalia or leprosaria, xenodochia, eleemosynaria, or even domus dei, the houses of God. Local documents make clear that hospitals could be referred to as monasteries, and were understood as falling under this broad category for houses dedicated to the communal religious life.