The Forsyth County Courthouse is located at 50 West Fourth in the central business district of Winston-Salem and is surrounded by both historic and modern office buildings. As it appears today, the courthouse is a substantial building that occupies an entire city block in the manner of grand public buildings.

The courthouse, which reached its current appearance in 1960, incorporates the 1926 Beaux Arts courthouse designed by the architectural firm of Northup & O’Brien and interior elements of the 1896 Romanesque Revival–style courthouse. Standing three stories high on a raised basement and sheathed with limestone, the central core is the 1926 courthouse, which incorporated some of the walls and interior features of the original 1896 courthouse. Between 1959 and 1960, additions were built onto the front and rear, creating its current form. The interior features elements of each of the three building campaigns that created the current building. The 1959–1960 additions include the front and rear stairs, an elevator, and additional office space. Also located on the grounds are three monuments: a statue of a Confederate soldier, a monument and flagpole dedicated to World War I soldiers, and the Good Samaritan monument.

The building is listed on the National Register of Historic Places (see the National Register Nomination) and is designated by the City of Winston Salem as an Historic Landmark.