A hospital which is riddled with asbestos and does not meet fire safety standards will cost £250m to put right, health officials claim.
Plans to bring Ysbyty Glan Clwyd in Denbighshire up to scratch are to go to the Welsh Assembly Government.
A large H-block at the centre of the hospital was built in the 1970s and does not have ceiling fire-breakers.
Conwy and Denbighshire NHS Trust said it was easier to demolish and rebuild, rather than refurbishing the block.
The trust's chief executive, Gren Kershaw, said the building in Bodelwyddan was designed in the 1960s, built in the 1970s and eventually opened in 1980.
"As it is, it is not unsafe to staff, patients or the public. It is only unsafe if disturbed"
He said: "The building has some structural problems which do not meet today's requirements, and that is the big issue.
"They were okay then, but not okay now.
"The steel girder construction of the building is coated with asbestos and that would need moving if we were to renovate.
"It was just about acceptable to use it when the hospital was built.
"As it is, it is not unsafe to staff, patients or the public. It is only unsafe if disturbed.
"Sorting it out is a really big job, and an expensive job."
He added: "Refurbishment would be a really difficult job, with doctors and nurses working in dust and in the middle of building work for 10 years.
"A new building on the outside could take five years less.
"Although the Welsh Assembly Government haven't accepted it yet, you could say they are looking very seriously at that option, and I am hopeful that by the end of the calendar year or early next year, a decision will have been made."
Under the plans, the H-block - which houses 12 wards, including intensive care - would be demolished.
New buildings would be constructed around the outside of the current site, leaving a green "heart" at the centre.
New wards would also be built on the main car park, which would make way for a new multi-storey facility.
'Exciting time'
To renovate the existing site would also cost an estimated £250m, but it could take twice as long to complete.
A new building would be constructed on the main car park, which would temporarily house wards as they were being renovated.
Departments would then move back to the old building once work was completed.
The trust's preferred option is to rebuild, which it claims would also provide more space for patients.
Mr Kershaw added: "They are only plans and have not yet been agreed by the Assembly. But it promises to be an exciting time."
A spokesman for the Welsh Assembly Government said: "The trust is looking at two main options - one to refurbish those parts of the site needing to be improved and one to replace those parts of the site with a new build.
"The business case being developed by the trust will recommend to the Welsh Assembly Government which option should be implemented.
"The trust is keeping the assembly government appraised as planning continues."
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