This study investigated the current design circumstances of an office as well as employees’ perceptions of the office environment in relation to their perceived health, drawing on sense of coherence theory (comprehensibility, manageability, and meaningfulness). Previous studies have related the physical office environment to employee health. However, most studies have focused on alleviating negative effects, while health-promoting potential, including employee sense of coherence, has been overlooked. This study adopted a mixed method case study approach, combining semi-structured interviews with employees, structured observations, and analysis of architectural drawings. The results indicated that employees’ perceptions did not always align with the ideas behind the architectural design and that employees understood the environment differently. The study also highlighted the interrelations (and contradictions) among the different components of sense of coherence. The findings imply that organizations may need to prioritize which components of coherence should be supported most by the office environment. It also suggests that case-specific design aspects should play a more central role in studying and conceptualizing healthy office design and that design solutions should be continuously modified during the use phase, while ensuring employees’ participation. The study concluded that an ‘ideal’ office environment should not be the goal. Instead, office design should provide an environment in which employees are able to cope with challenges in comprehensible, manageable and meaningful ways.