The overall atmosphere is one of simplicity, serenity and understated sophistication. It is reflective of the 14th-century Devotio Moderna movement, and contains complex Christian symbolism, subtly juxtaposing Old and New Testament iconography. The sculpted figures in the archway depict biblical scenes of sin and punishment, signaling the advent of Christ's sacrifice, with an over-reaching message of the "Fall and Redemption of humankind". Inside the archway, surrounded by four angels, is the Holy Family; beyond, a landscape extends into the far background.
Art historians have suggested completion dates ranging from the early 1440s to the early 1460s, with c. 1455 seen as probable. The panel was acquired by Andrew Mellon in the 1930s, and was one of several hundreds from his personal collection donated to the National Gallery of Art in Washington. It has suffered damage and was restored in the early 1990s for an exhibition at the Metropolitan Museum of Art.
The panel measures 127.6 cm × 94.9 cm (50.2 in × 37.4 in), unusually large for a 15th-century Early Netherlandish single-panel painting. It covers four oak boards. Although there is no evidence of missing wing panels, its size suggests it was a central altarpiece of a large triptych. Art historian Joel Upton writes that with its size, style, tone and composition, Christus painted "an Andachtsbild, given monumental, ciboriumlike dimensions". The distinction between the figures and the space around them is characteristic of Christus, as is its one-point perspective. The background landscape is typically serene, as are what Upton describes as the "charming, almost doll-like figures who make up the cast of characters."
The panel is set in a shed enclosed by two pillars and an archway, rendered in sculpture-like grisaille. Each pillar is supported by a relief hunched figure (atlante) at the base, holding the weight on its shoulders. On each pillar stand statues of Adam and Eve – Adam on the left and Eve to the right. A marble threshold connects the two structures. On the top corners of the arch are two spandrels; the archivolts contain six biblical scenes in relief from the Book of Genesis, depicting the Fall of Man. Two are of Adam and Eve; their expulsion from paradise and Adam tilling the soil. The others are of Cain and Abel: their sacrifice to God; Cain slaying Abel; God appearing to Abel; Cain expelled to the Land of Nod.
In the shed Mary and Joseph share an intensely private moment before the Annunciation to the shepherds of the Christ child's birth to the shepherds. They are rendered in bright colors. Mary wears a long flowing blue robe, Joseph a green-lined red cape over a brown robe. He holds his hat in hand, and his pattens are respectfully removed, left lying on the ground. They gaze reverently at the newborn figure of Jesus who lies on Mary's robe. Mary's features have a softness and sweetness more characteristic of Christus's later paintings and remarkably similar to his Madonna of the Dry Tree, according to Maryan Ainsworth. Kneeling in adoration to either side are four small angels.