The Dutch Reformed Church Middelburg-Karoo is the result of the merger on 13 September 2010 of the NG Gemeente Middelburg-Cape, which was founded on 19 May 1852 as the 10th congregation in the later Synod of the Eastern Cape and the 51st oldest congregation in the NG Church, with the congregation Middelburg-Uitsig.  Middelburg-Cape was the third-oldest congregation to officially cease to exist or to be re-established through incorporation or merger.

By the middle of the 19th century, the Colesberg congregation also included the Rhenosterberg ward. Due to poor transport facilities at the time, as well as the long distances to the church in Colesberg, congregation members in this remote ward strove to establish a separate congregation. In this, they were supported by members in the adjacent congregations of Graaff-Reinet, Cradock and Richmond.

After a list of names of persons who were interested in establishing a new congregation was submitted, the Colesberg church council decided on 6 April 1852 as follows: “The Most Reverend Church Council of Colesberg hereby gives full permission for the new establishment at Driefontein and prays that the All-Honored Head of the Church will govern the interested parties favorably and will soon make their intentions come true.”

Thus it came to pass that the new congregation, Middelburg, was founded on 19 May 1852 on the farm Driefontein, which had been purchased for this purpose through the mediation of the two gentlemen Willem S. Smit and Henning J.H. Coetzee. The founding meeting was characterised by great enthusiasm. Everyone agreed on the name of the congregation because the farm Driefontein is situated almost in the middle between the neighbouring towns (being a distance of 10 hours on horseback from Colesberg, Cradock and Richmond, 12 hours from Graaff-Reinet and 16 from Burgersdorp).

The first consultant was Rev. John Murray, then pastor of the Dutch Reformed Congregation Burgersdorp and later professor at the Seminary in Stellenbosch, and the first pastor Rev. William Murray, his younger brother. It must have been a sad experience for him when the Reformed Church Middelburg, Cape, was founded on 1 December 1860. He was still unmarried and lived with one of his elders, H.T.J. van der Walt, co-owner of the farm Grootfontein, on which the new congregation was founded. This old father also joined the Reformed Church and was elected as an elder.

The first church building was known as the “North Church” and was built on the corner of Van Reenen and Loopstraat. As early as 1853, the church council decided to add an addition to the church. Later, the “North Church” was used as a school. This was during the time of Rev. William Murray that the church council decided to build a new church building. The cornerstone of that church was placed on 22 October 1855 and the church was solemnly inaugurated on 9 October 1858.

In 1903 it was decided to enlarge the church by adding a wing on the west side, which would provide 450 seats on that floor alone, while the space under the tower previously served as a sanctuary, a small sanctuary was also built onto the tower. A new organ was installed and a new pulpit in 1911. The enlarged church was inaugurated on 2 April 1904.

In 1966, cracks began to appear in the tower and Rev. Mentz noticed that there was fine dust falling while the bell was ringing. The building committee appointed a structural engineer and it was recommended that the tower be demolition. Tenders for the demolition and building of a new tower closed at 12:00 on 29 March 1967. At 15:35 the tower collapsed. This caused so much damage to that the building had to be demolished.

The new church building was inaugurated on 6 September 1969.