In 1915, following his victory at the Battle of New Orleans, Andrew Jackson was presented by the State of Tennessee with a ceremonial sword on the steps of the church. The building was destroyed by a fire in 1832, but a second building was constructed on the same site. This second church hosted the inauguration of James K. Polk (the future president) as governor of Tennessee in 1839, but that building, too, burned down in 1848.
At that time, the distinguished Philadelphia-based architect William Strickland was in Tennessee, designing and supervising construction of the State Capitol. The congregation hired Strickland to design their new church. Construction began in 1849 and ended in 1851, when it was dedicated on Easter Sunday. At the time it was built, the congregation had only about 350 members. However, they had Strickland design a space to seat over 1000 people and thus ran out of money to fully finish the building. According to the National Historic Landmarks program, the church was Strickland's largest and only full Egyptian temple. Exterior elements that identify the style as Egyptian are the cavetto cornice, the lotus-bud capitals, and the designs of the sun disk and cobra. It was nicknamed the Karnak on the Cumberland, because Strickland had modeled it on the temple to Amon-Ra at Karnak.
In 1862, during the Civil War, the church was appropriated by the occupying Federal forces and converted into a military hospital. In 1865, it was released by the Union and given back to the congregation. Receiving reparations from the US government, they preceded to try to complete the construction left unfinished in 1851. They added the columns and the entablature in 1871 and redesigned and refurbished the interior in 1880.
In the 20th Century, the church served as a shelter for flood victims in 1927 and 1937, as well as for thousands of US servicemen during the Second World War who were on leave in Nashville. Although the First Presbyterian congregation decided to move to a suburban Nashville location in 1954, the old church was spared and its name changed to Downtown Presbyterian Church. It still serves the needs of people in the area.
A celebrated feature of the church is its pipe organ. This was installed in 1913, and was renovated in 1972 and again in 2008. The church holds annual organ recitals that attract players and listeners from great distances.