Revised plans for the future of Calderdale and Huddersfield hospitals have been drawn up after original proposals to centralise A&E services in Halifax met with a huge public backlash.
NHS bosses first proposed to knock Huddersfield Royal Infirmary (HRI) down and replace it with a smaller site.
The plan met with protests and legal action from the campaign group Hands off HRI, and in May last year former health secretary Jeremy Hunt ordered a re-think after it was reviewed by an independent panel.
Concerns included longer journey times to hospital for A&E patients if Huddersfield no longer had a full A&E department.
New plans were then published which scrapped the HRI demolition and said 24-7 emergency care would be retained in both towns.
Now a Strategic Outline Case report which sets out how £196.5m of Department of Health money will be spent to keep both hospitals open has been released by Calderdale and Huddersfield NHS Foundation Trust.
While A&E services will remain at HRI, all "blue light" ambulance patients who are in a serious condition or are expected to need hospital admission will be taken to an expanded Calderdale Royal Hospital (CRH)).
Around £177m will be spent on the hospital in Halifax, with extra room for more A&E admissions and more car parking space.
The report said: "The proposed model will make use of both existing hospitals. Both sites will provide 24/7 A&E services and a range of day-case, outpatient and diagnostic services - although whenever possible, services will be delivered in the community and closer to people’s homes."
There will be around 840 beds at the two sites, some 676 at CRH and 162 inpatient beds at HRI, which will carry out more planned medical procedures.
The report said: "The total number of hospital beds will remain broadly as they are now whilst services are developed in the community and demonstrate a sustainable reduction in the demand for in-patient hospital care."
NHS bosses previously raised concerns over the condition of ageing HRI, which was built in the 1960s and has an estimated £95m backlog of maintenance work.
The report said a £20m investment will "enable adaptation of existing buildings and to address the most critical backlog maintenance requirements enabling the continued use of some buildings on the HRI existing site."
It added: "These proposals do not fully address the backlog maintenance requirements at HRI and the trust will therefore continue to manage a very high risk in terms of the condition and reliability of buildings at HRI."
Health bosses hope the plan will secure the long-term future of the NHS trust, which is around £43m in deficit.
They said the changes are needed to provide for a growing population and more people living with complex health conditions.
The report said: "These challenges and their potential solutions have been debated for a number of years in Calderdale and Huddersfield and whilst day to day operational plans are in place to ensure the care and safety of patients within the trust’s clinical services, a sustainable solution is urgently needed."
Calderdale and Huddersfield NHS Foundation Trust said it was monitoring the condition of the HRI buildling.
Director of finance Gary Boothby said: “The trust has an ongoing risk assessment programme underway which enables us to identify day to day the areas of the building structure at HRI which need urgent action to ensure it is safe for our patients, our staff and visitors and that work will be carried out accordingly as a priority.”