This study examines how three municipal hospitals on the Swiss Plateau – in Fribourg, Bern and St. Gallen – coped with climate anomalies in the early 1640s that coincided with the Komagatake/Parker double volcanic eruption. The eruption led to catastrophic consequences in regions such as China, Japan and northern Europe. Unlike these regions, Switzerland did not experience a comparable famine. Rather than focusing on a narrative of disaster, the study analyses how local authorities coped with climate anomalies. The focus is on the cities of Fribourg, Bern and St. Gallen and their respective municipal hospitals (care institutions), whose economies and agrarian sectors (viticulture, husbandry, dairy production and crop cultivation) are analysed. Between 1639 and 1643, the study region experienced cold springs and summers, likely resulting from a combination of internal stochastic variability and volcanic forcing from the double eruption. All sectors of the hospitals’ agricultural production were affected simultaneously, due to their interconnectedness. The hospitals’ greatest vulnerability was the extent of their involvement in direct cultivation. Staple food shortages and high prices caused by multi-annual climate anomalies and the impacts of the neighbouring war between France and the Franche-Comté led to a subsistence crisis across the Swiss Plateau. Coping strategies were implemented on two levels. Hospitals adopted internal measures, such as switching from exporting to importing foodstuffs or reducing unnecessary expenditure, to increase the availability of staple food products. They also benefited from external measures ordered by the city authorities, who issued mandates to ensure food security for their populations. Although the available hospital records do not show an obvious increase in recorded deaths among residents and the authorities’ economic policy coincided with a peasant revolt in Bern in 1641, the subsistence crisis nonetheless placed the hospitals under considerable pressure. While the study primarily focuses on urban populations, further research on rural populations would be useful to examine how they coped with the subsistence crisis.