LEAVE: To get this ending you must

• Try to stay at full health as much as possible.
• Never get hit alot and avoid fighting.
• Listen to the whole message in the corridor before last Boss.
• Don't make Maria remind you how to get to the Hotel

IN WATER: To get this ending you must

• Never heal yourself straight away, try to have low health.
• Examine Angelas' Knife after taking it off her.
• Listen to the whole message in the corridor before las Boss.
• Listen to the headphones in the reading room in Hospital.
• Read the Diary on the Hospital Rooftop.

MARIA: To get this ending you should

• Always go where Maria tells you.
• Hang around her alot in town before you get to the Hospital.
• Make sure she gets attacked as little as possible.
• In the corridor before last Boss Fight, run and ignore message.
• When Maria lies down check on her alot.
• Re-enter her cell when you leave for the Labyrinth.

DOG:  After you've baten the game three games and have 'Leave, In Water & Maria' endings, play until you meet Maria in the park then go towards the Gas Station. In between the Gas Station and the Bowling Alley will be a chain-link fence with an open section. Go inside and you'll find a Doghouse, search infront of the Doghouse to find a Dog Key. Now play the game until you've finished listening to Marys' voice after watching the video tape. Go out of the doors, turn right, and go to the observation room. The Dog Key will fit its set of doors. Go inside to see a funny ending.

In the "Leave" and "In Water" endings, the woman in the room is Maria once again, dressed as Mary and making a final attempt to get James to take her. James rebuffs her, however, and she turns into a monster similar to the hanging monsters in the hospital, becoming the final boss. Following her defeat, in the "Leave" ending, James is next seen having a final meeting with a dying Mary, to whom he confesses he killed her to reclaim his life from the strain of looking after her. Mary forgives him, handing him a piece of paper which is presumed to be the full content of the letter that he had in the game, and James is last seen leaving the town through the graveyard with Laura following him ahead as the letter is read onscreen. The "In Water" ending is identical up to the point that Mary dies during the meeting before forgiving James, and he takes her body into the car he arrived in and drives into Toluca Lake, killing himself. A special ending entitled "Rebirth" (available only during a replay game) will also end with James killing Maria, but the final scene shows him in a boat with Mary's body, planning to revive her using secret occult objects the player can collect throughout the game.

The "Maria" ending, however, is radically different from these three. If the player takes actions that seem to show an attachment to Maria (checking on her frequently, keeping her out of harm's way), the woman in the room will be Mary, who has apparently not forgiven James for killing her. She will then turn into the final boss as the same monster Maria becomes, and after her defeat James dismisses her as being just another hallucination. He then discovers Maria, inexplicably resurrected (again), and leaves town with her as she hands him what is presumed to be the full letter. After the letter is read in the final cutscene, however, Maria starts noticeably coughing, implying she has the illness Mary suffered from and the events that drove James to the town may repeat themselves.

There are also two joke endings available on replays. The first, "DOG", ends with James discovering beyond a normally locked door a Shiba Inu which has apparently been controlling all the events of the game from a large computer console. The second, "UFO", is a continuation of the UFO ending of the first game added in the Xbox port/Director's version in which James is abducted by a group of aliens with the first game's protagonist, Harry Mason.