Plot

Travis wakes up some time later on a bench in Central Silent Hill. After recalling the events of the previous night, Travis travels to Alchemilla Hospital in hopes of finding the girl's condition. Inside of the hospital, Travis briefly meets Dr. Michael Kaufmann, but is unable to find out any information as he claims that the hospital has received no new patients. On the second floor of the hospital, Travis is suddenly attacked by a nurse. After battling with the nurse and continuing his search in the hospital, Travis is confronted by a large mirror with an unusual reflection. On the other side of the mirror (which reveals the Otherworld), the brown haired girl appears and Travis is transported to the hospital's Otherworld. Later on, Travis is faced by a convulsing monster and, after its defeat, finds a strange triangular piece belonging to an object known as the Flauros. The brown-haired girl appears again and Travis loses consciousness once more to the siren.

Back in the Fog World, Travis wakes up in the hospital lobby, where he meets Lisa Garland, a nurse who informs him about the sanitarium. Making his way through Silent Hill, Travis passes through the town's butcher shop, and inside he witnesses the murder and mutilation of a nurse by a large monster called The Butcher.

Once Travis arrives at Cedar Grove Sanitarium, he runs into Dahlia Gillespie, the woman he spotted at the fire. Travis questions her and she gives him a set of convoluted and confusing answers, revealing that her daughter is Alessa Gillespie, the girl burned in the fire. During the exploration of the sanitarium, it is revealed that Travis' mother, Helen Grady, had attempted to kill him, and that she was held in the female isolation ward. Voice recordings in the sanitarium tell of how Helen claimed that she was "all better now" and wanted to see her son. Travis reaches his mother's cell and finds her otherworld counterpart in a large, triangular prism with spikes attached. After defeating her, he finds another triangular piece and Alessa appears as Travis, once again, slips into unconsciousness.

When he wakes up, Travis finds a theater ticket nearby, insinuating that he should check out Artaud Theater. When Travis enters the theater's main auditorium, he meets Lisa again. Lisa describes her dream of being an actress and proceeds to tease Travis, using her "acting skills" before leaving. During his search of the theater, Travis encounters new monsters and is also shown that Alessa used to visit the theater when the actors were rehearsing their rendition of Shakespeare's The Tempest. The character costume of Caliban had frightened Alessa, and she quietly retaliated by psychokinetically causing the actor to complain of a headache and nosebleed. Travis eventually discovers that he can change the theater stage's props and scenery to create different Otherworlds. The final scene change reveals the dark and dreary home of the Caliban. Defeating the creature, Travis picks up another piece of the Flauros. By now, Travis has begun to catch on to Alessa's patterns; however, he still has a great many questions that have gone unanswered. Alessa calls the siren and Travis, once again, falls unconscious.

Travis wakes up in the theater lobby in the Fog World and promptly discovers the mutilated body of an Ariel. The corpse contains a key to the motel that Travis and his father used while visiting his mother. Travis makes his final trek through the streets of Silent Hill, passing through a bookstore and a general store, and ends his journey at the Riverside Motel.

A flashback begins as Travis enters the motel lobby, revealing more of his past. Travis struggles through a long and dangerous stay at the Riverside Motel, involving many monsters previously unseen in Silent Hill, numerous transitions between the Fog World and the Otherworld, and various puzzles and searches. After making his way through the majority of the twists and turns and trials of the motel, Travis engages the Butcher in a fight. Though fearsome, the Butcher is slain by Travis who, after pondering the demon's blade, impales its corpse and walks away. Travis continues to search for answers regarding his family and encounters Dr. Kaufmann and Lisa Garland in a room with drugs and sexual tension between them; Lisa angrily storms out of the room and Dr. Kaufmann follows her after threatening Travis and locking the exit. Travis escapes using a mirror in the bathroom and finally finds the key to the room in which he stayed many years ago with his father. After opening the door to Room 500 and walking down a long diagonal shaft to another doorway, another flashback ensues, revealing the corpse of Richard Grady hanging by a noose. As young Travis weakly attempts to converse with his father and beg him to respond, Richard opens his eyes and begins to speak. He tells Travis that it's time he "faced up to what happened". The figure then begins to twitch uncontrollably, finally becoming a screaming, tubular monster trapped in a box hanging from the ceiling. Travis painfully defeats the memory of his father and receives yet another piece of the Flauros. This time, Travis is visibly shaken and turns on Alessa when she inevitably appears. Once again sirens ring out and Travis collapses.

After fulfilling his purpose in the Motel, Travis re-awakens in the basement of the hospital. Inside, he finds the "Present Piece", the center piece of the Flauros. After reconstructing the mystical item, Alessa reappears. Exiting the Hospital, Travis is again accosted by Dahlia who accuses him of freeing Alessa. Turning back, Travis sees Alessa has regained her powers as she begins to distort the town into a burning, nightmarish state. He escapes into the streets of Otherworld Silent Hill, otherwise referred to as "Nowhere". Using a child's scribbled map, Travis escapes an overwhelming number of monsters and makes his way to a far door, indicated by the map as simply "Go Here". Travis enters the door, belonging to the Green Lion Antiques shop and soon comes upon members of the Order performing another ritual on the burned Alessa. Travis is then sedated with sleeping gas and drawn into a strange, nightmarish reality in which he faces the entity within the Flauros. Travis defeats the demon, making a light shoot out of the Flauros that makes a glowing infant-like form appear above Alessa's body. This is when the various endings occur.