The church's origins lie in the 12th-century Chapel of Our Lady of the Maerct. In 1515, the relic of Saint Bartholomew was brought in a solemn procession from the neighboring village of Sint-Martens-Lierde to Geraardsbergen. The late Gothic parish church henceforth bears the name of this apostle-martyr. Bartholomew is invoked against nervous and skin diseases, and is, among other things, the patron saint of tanners. The saint's relic is housed in a magnificent silver shrine (1719).
In the mid-eighteenth century, the time was ripe for a modification to the French rococo style. The town hall, too, was adapted. The Geraardsbergen carpenter-sculptor Gilles de Ville and several colleagues created various ornate pieces of furniture, including the naturalistic pulpit.
At the end of the nineteenth century, the Ghent architect August Van Assche drastically turned the clock back to the Middle Ages. The church regains its Gothic exterior. Inside, a magnificent neo-Gothic interior, inspired by Louis Bert de l’Arbre, now shines, with the choir as its centerpiece. The godfather of neo-Gothic architecture in Geraardsbergen is so delighted with the prestigious commission that he painted the choir and transept entirely free of charge. Uniquely, the interior has been exceptionally well preserved, from the stained-glass windows and altarpieces to the shining lights on the choir stalls. This is almost unheard of in Flanders.