While the International Monetary Fund (IMF) has evolved considerably since its foundation 60 years ago, the past few years have brought fresh challenges. This paper discusses four key areas in which developments have led to a rethinking of the institution’s role: the emerging market financial crises, the changing role of conditionality, the phenomenon of prolonged use, and the search for a clearer role in low-income countries. In response to these challenges, important reforms have been undertaken to strengthen the institution’s effectiveness, but important tensions remain unresolved. The paper discusses the implications for the governance of the institution.