In 1620 a raid on Voronezh lands by Lithuanians was successfully repelled and in gratitude a wooden church was built and dedicated to St Alexius, Metropolitan of Kiev and All Rus, on whose feast day the attack occurred. Later this church became the Aleksievo-Akatov Monastery. The St Alexius' church was rebuilt in stone in 1674 and a second floor was completed in 1755. In the late 18th century walls and more stone auxiliary buildings were added.

In 1804 work started on replacing the original church with St Alexius, Metropolitan of Moscow's Cathedral which still stands today. The cathedral was built in the Russian revival style and was eventually completed in 1819 after several setbacks. The original stone church was only demolished in 1879 when new construction work started on building a bell tower. The first tier of the bell tower housed the St Sergius of Radonezh's Church which was consecrated in 1903. In 1931 the monastery was closed and during the war the upper tiers of the bell tower were destroyed leaving only St Sergius of Radonezh's Church. After the war the monastery's buildings were used as a museum until 1990 when the territory was returned to the Orthodox Church, which reopened it, although now as a convent rather than a monastery.