The fate of Albert C. Ledner’s National Maritime Union headquarters was all but sealed this morning when the Landmarks Preservation Commission approved the latest iteration of the tower proposed by St. Vincent’s Hospital for the site of the much-debated Greenwich Village landmark. At the same time, a coalition of preservation groups and neighbors opened another front in their long-running battle against the hospital and its plans, with a new proposal that included a hardship application, which the commission reluctantly supported in October. While today’s vote was not the last—the commission still has to determine the appropriateness of the condominiums—the biggest hurdle is over. Or, as Tierney put it before the vote, “This is a threshold point.”

Throughout the public review process, a quiet, though occasionally boisterous, battle between health care and preservation has been playing out. “There are good arguments on all sides of this, but the foremost is still the mission to heal, mend, and care for the community,” commissioner Christopher Moore said in casting his supporting vote for the project. “I can say, if O’Toole is going down for a good cause, this is a great cause.”

Every commissioner who voted for the project found that the concessions made over the course of the public review had greatly improved the proposed building, which had once stood as high as 329 feet, before being reduced in June to 299 feet, and now rises 278 feet, though the final version technically reaches 286 feet at the setback.

To reduce the height, cooling towers that had been located in the basement have been moved to the roof of the adjacent Handling Center, a small building across 12th Street that serves as the loading dock for the hospital. This allowed for the transfer of one floor from the tower to the basement, while improving the appearance of the Handling Center. “What had once resembled a single-story suburban drive-in is now a much more appropriate building,” commissioner Fred Bland said. Additionally, a few inches were shaved off each floor, with diagnostic floor heights reduced from 16 feet to 15 feet 4 inches, and patient floors from 13 feet 4 inches to 13 feet.

Another change was the addition of terra cotta louvers to the ribbon windows that many commissioners decried in December as too institutional. While the ribbon windows still exist, some panes have been screened over with louvers in a pattern the commission found appropriate for the Village. Similarly, the entry and street wall have been enlivened with windows that more closely resemble the Village’s ubiquitous row houses, while an art installation has been proposed for one wall of the Handling Center.

Even the commissioners who voted against the project conceded that much thought had gone into the tower’s latest iteration. “I think what’s been proposed at the ground floor is generally an improvement and is appropriate,” commissioner Stephen Byrns said, “but my threshold is still the height, and it’s still too tall.” Commissioner Roberta Brandes Gratz, another dissenter, actually saw Pei Cobb Freed’s due diligence as a strike against the project. “I must say the innovations up to now are considerable, though that same approach could be applied to renovating the existing building or working on an alternative site,” she said.

For its part, the development team agreed that the process had been worth it. “We believe the design has actually become stronger through this process,” Ian Bader, the partner-in-charge, said. “Even though the situation at times has been daunting, the result has been far better for it.” Rudin said he saw the vote as a confirmation of the team’s hard work, adding that he expects to go before the commission with the condominium project within “the next couple of months, as soon as their ready.”

Preservationists were disappointed by the vote, if unsurprised. “This is basically what we expected,” said Melissa Baldock, a preservation fellow at the Municipal Art Society. “The vote fell along the lines of the hardship, so we really see it as more a confirmation of that than a vote for this building.”

Correction: An earlier version of this story said the story would cost $900 million and that the commission supported the hardship in October. AN regrets the errors.