Background: In July 2004, Saskatchewan became the first province in Canada to provide all residents with access to The Cochrane Library (the Library). Objectives: The purpose of this study was to promote and evaluate the use of the Library over three years. Evaluation of the use of the Library continues. Methods: Since September 2004 to December 2006, 46 training sessions were offered to promote the use of the Library. Attendees who consented to participate were telephoned and audiotaped interviews were conducted at three (n = 94), six (n = 71), nine (n = 79), and 12 months (n = 72) following the sessions. Usage of the Library continues to be tracked using data available from Wiley-Blackwell. Results: Data from Wiley-Blackwell revealed that from October 2004 to January 2008, the component of the Library most frequently accessed was the Cochrane Database of Systematic Reviews (abstracts = 28,981; full texts = 27,279). Telephone interviews with participants revealed that the majority (65.2%) used the Library at the three month interview, however, this proportion fell to 27.4% at the twelve month interview even though most (83.6%) reported that the Library was somewhat to very helpful. Use of the Library also appears to reflect the loss of the Librarian in mid December 2006 who conducted the training sessions. For example, use of the Library has declined over the last year with the lowest user sessions and retrieval of abstracts and full texts occurring in December 2007. Conclusions: Many of the participants reported that they had difficulty using the Library even after attending a training session, and many practitioners and consumers not involved in the study may be unaware of the Library. Providing the Library to all residents of Saskatchewan does not necessarily equate to use of the Library. Other strategies, such as continued training sessions, are needed to ensure that residents are aware of and appropriately use this excellent resource. Use of the Library will promote evidence-based decision making by healthcare providers and consumers which will result in improved health outcomes.