The manuscript was copied, probably slightly before 1450, by someone who signed himself Salthows on the bottom portion of the final page, and contains annotations by four hands. The first page of the manuscript contains the rubric, "Liber Montis Gracie. This boke is of Mountegrace," and we can be sure that some of the annotations are the work of monks associated with the important Carthusian priory of Mount Grace in Yorkshire. Although the four readers largely concerned themselves with correcting mistakes or emending the manuscript for clarity, there are also remarks about the Book's substance and some images which reflect Kempe's themes and images.
Kempe's book was essentially lost for centuries, being known only from excerpts published by Wynkyn de Worde in around 1501, and by Henry Pepwell in 1521. However, in 1934 a manuscript (now British Library MS Additional 61823, the only surviving manuscript of Kempe's Book) was found by Hope Emily Allen in the private library of the Butler-Bowdon family. It has since been reprinted and translated in numerous editions.