In 2004, he was named president and CEO of the Clinic, pushing the heart surgeon into the national spotlight as he stood holding the reins of one of the country's most well-known health care institutions.
"I was never a public figure before this," Cosgrove said. "I used to go to a party and I would be introduced as Anita Cosgrove's husband, because no one knew me because I was locked up in the operating room. And all of the sudden, I became a very public figure in a matter of about three weeks."
To the C-suite, Cosgrove brought his sense of curiosity and desire to do things right.
He led the Clinic as it grew within the region, solidified its reach across the nation and stretched around the world. Between 2004 and 2016, revenues more than doubled from $3.7 billion to $8.5 billion, and total visits grew from 2.8 million to 7.1 million.
In that time, the Clinic bolstered its research efforts, with research funding growing from $121 million to $260 million and the number of physician-scientists increasing from 1,800 to 3,400.
The Clinic opened new buildings, most recently a hospital in Avon and the Taussig Cancer Center on its main campus, and shuttered some as well. In his tenure, the Clinic closed both Lakewood and Huron hospitals, decisions that were met with backlash from their communities. Cosgrove stands by the decision, saying that the Clinic did the right thing for both facilities, which were underutilized.
"We put in their place an outpatient facility that was specifically tailored to that community," he said. "Health care is changing. There's less inpatient requirements and more outpatient, and that's what we tried to do."
The squabbles over hospital closures weren't the only tumultuous periods during his tenure. In 2007, the Clinic stopped hiring smokers, a point of contention for many. In 2015, he closed the McDonald's on the Clinic's main campus after an almost decade-long crusade to rid the campus of the fast food restaurant.
And in the spotlight, he has made a few off-kilter statements. Several years ago, he told The New York Times that, if it were legal, he wouldn't hire obese people. He ultimately apologized for those remarks, but told employees that there's still "much more we could do to prevent chronic diseases if we take measures to eat healthier, exercise and quit smoking."