With difficulty. It really depends on how the building was originally constructed. Building practices and standards evolved over the decades, so the strategies for updating the amenities can vary a great deal depending on the building. And the condition of the building at the time of the renovation.
Also very old buildings were built for the climate, so the design for ventilation back in the day, and the use of space generally, can be different in warmer or colder climates.
In particular heating / air conditioning (HVAC) takes a lot of space and is not something planned by builders in previous eras. Some buildings in warmer climates were built with very high ceilings to allow more air flow. Ceilings that can be dropped to allow space for HVAC systems. In other buildings sometimes ducts can be run along the top of the wall next to the ceiling and boxed in so the ductwork isn’t visible.
For electricity, plumbing and so forth, it can be easier to open up some or all of the walls to install such infrastructure – and then putting the walls back the way they were originally, having preserved the material. This work needs careful study of how walls were built, as they probably weren’t made of modern material or fit together by modern means. Sometimes not many nails were used, rather thick wood panels were notched to fit together by the pressure of the entire span.
Depending on the building, it’s age and intended purpose (a home or business), and so forth, some amenities might be best left out because they have too much impact on the structure and the historic elements.
It’s important to look at how the building sits on the property where it is located, the drainage, connection to city resources, and so forth. That has changed over time. You don’t want to neglect making outside changes to prevent even mild flooding and other environmental damage to the building.
https://www.architecture.com/knowledge-and-resources/knowledge-landing-page/tips-for-retrofitting-a-historic-building
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