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The first elections to Medway council took place on 1 May 1997. Those elections established a "shadow authority" until Medway council was formed on 1 April 1998. Subsequent elections were held on 4 May 2000 and 1 May 2003, since when elections have been held every four years on the first Thursday in May.

There have also been various by-elections to Medway council seats since 1997, following the death or resignation of a sitting councillor. However, if a councillor dies or resigns within six months of a scheduled full election, then a by-election is not held and their seat instead remains vacant until the next full election.