The establishment of a hospital at Elishaw, during the medieval era (Hodgson 1827, 20, 146; Hodgson 1916: 8), may be related to the possible deviation, discussed above. Situated near the junction of two routes and at the very limit of recorded permanent settlement in this area, the institution may have served as an ultimate lodging place on the limit of the inhabited, cultivated realm for travellers making the arduous border crossing, as Hodgson (1827, 146) suggests, in addition to providing a hospice for the local poor and sick. Certainly such a very limital, pioneer location is difficult to parallel exactly with regard to other ecclesiastical establishments in the area.
The nunnery of Holystone, in neighbouring upper Coquetdale, whilst situated high in the dale nevertheless still lay below and close to the capital of the Umfraville liberty at Harbottle. Gilbert de Umfraville's claim, during legal proceedings at Newcastle-upon-Tyne in 1279, of the right to levy a transit toll at Elishaw on Scottish citizens, though not on Englishmen, provides a further indication of Elishaw's 'frontier' status (Northumb. Assize R. SS 88, 373). It was evidently the highest permanently settled point where what was in effect a customs toll could be levied on Scotmen crossing over the border into Gilbert's liberty.