Sir Thomas Drew was the first architect and the foundation stone was laid on 6 September 1899 by the Countess of Shaftesbury. The old parish church of St. Anne had continued in use up until 31 December 1903, while the new cathedral was constructed around it. The old church was then demolished. The Good Samaritan window, to be seen in the sanctuary, is the only feature of the old church to be retained in the cathedral.
Edward Carson, the leader of the Unionist cause at the time of the Home Rule Crisis, was buried in the south aisle of the Cathedral in 1935. In 1941 the cathedral was almost destroyed by a German bomb which caused extensive damage to surrounding properties. In 1955 work began on the construction of the ambulatory, at the east end of the cathedral. This work was dedicated in 1959, but it was not for another ten years that it was possible to begin work on the north and south transepts. The Troubles and inflation led to long delays and major problems with the financing of this work.
In April 2007 a 40-metre stainless steel spire was installed on top of the Cathedral. Named the “Spire of Hope”, the structure is illuminated at night and is part of a wider redevelopment planned for the Cathedral Quarter. The base section of the spire protrudes through a glass platform in the cathedral’s roof directly above the choir stalls, allowing visitors to view it from the nave.