In April 2002 Directly Observed Treatment - Short course (DOTS) centre was established in Nepal medical college teaching hospital(NMCTH) by National tuberculosis centre(NTC) with the aim to expand the services of DOTS to the general population. In this communication, we describe the experience of establishing a DOTS centre at Nepal's one of the premier medical institute and discuss the lessons learned. Since April 2002 to July 2004 (28 months), patients diagnosed with tuberculosis were enrolled for the treatment at the NMC DOTS clinic. 103 patients were diagnosed as suffering from tuberculosis, of them 8 patients were transferred out and 95 patients were given treatment at NMC DOTS clinic. Forty Patients were sputum positive cases, out of which 35 were new sputum positive cases and 5 were relapsed patients.20 patients had sputum negative pulmonary tuberculosis and 35 patients were diagnosed as having extra pulmonary tuberculosis. Cure rate of 97.0% (34/35) were achieved in the new sputum positive cases and 92.0% (37/40) in overall sputum positive cases. Despite tremendous patient load at tertiary care facility, it is possible to achieve a good sputum conversion and cure rate, by using DOTS.