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Columbanus established a number of important monasteries in Merovingian Gaul, Alamannia, and Lombard Italy between ad 591 and his death in Bobbio in ad 615. But what were the factors that lay behind his choice of these sites? Did he play an active role in the foundation process or was he at the whim of his royal patrons, who gave him these lands on which to establish his monasteries? This article proposes that a more complex and dynamic process underlay the choice of these sites, whereby Columbanus and his royal patrons acted in concert to appropriate ancient healing cult sites within a Christian pastoral framework. The commonalities shared by these sites reveal a pastoral element to Columbanus’ establishment of his monasteries. This has important implications for how these sites are interpreted and for understanding Columbanus’ role as a peregrinus and monastic founder on the continent.