What we now call Palazzo Reale is actually a large patrician residence built, expanded, and decorated over time with splendor, not only by the Savoy in the 19th century, but also by two great Genoese dynasties: the Balbi, who built it between 1643 and 1650, and the Durazzo who expanded it between the late 17th century and the beginning of the next century. The ceilings of the salons and galleries are frescoed by some of the most important names in local Baroque and Rococo decoration. Among the over one hundred paintings exhibited in the rooms are works by the best Genoese artists of the 17th century along with masterpieces by Bassano, Tintoretto, Luca Giordano, Antoon van Dyck, Ferdinand Voet, and Guercino.

The visit includes the monumental atrium with 18th-century stuccoes, the courtyard of honor, the suspended garden, and the noble apartment on the second floor with scenic representation environments such as the Throne Room, the Ballroom, and the Gallery of Mirrors.

On Saturday mornings (09:00 - 13:30) or on the occasion of temporary exhibitions, it is also possible to visit the Apartment of the Hereditary Princes, also known as the Duke of the Abruzzi's Apartment, set up by the Savoy on the First Noble Floor of the palace: this remarkable example of a royal apartment still preserves intact 19th-century furnishings, fabrics, and decorations.

The residence is part of the Rolli Palaces system and therefore since 2006 has been recognized by UNESCO as a World Heritage Site.