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, 3 Vice Presidents, Registrar, Assistant Registrar, Treasurer, the chairs of the regional councils for each of Northern Ireland, Wales and Scotland, 2 co-opted trustees and 3 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.