The College is governed by a Trustee Board. Members of the Board, as trustees, have the ultimate legal responsibility for the College. The Trustee Board comprises the President, three Vice Presidents, Registrar, Assistant Registrar, Treasurer, the chairs of the regional councils for each of Northern Ireland, Wales and Scotland, two co-opted trustees and three lay trustees. The Board is chaired by one of the lay trustees. 

Council, which reports to the Trustee Board, is focussed on the practice of pathology as a profession, which includes all the professional, clinical and educational functions of the College. Council members are not trustees of the College. Council is chaired by the President.