Silent Hill: Orphan takes place in the orphanage of Silent Hill. It starts out with telling the story of Ben who returns after 30 years. Now he is back at the orphanage to find out what really happened that night when nearly everyone at the orphanage was killed. The player starts out taking control of Ben but will later also get to play as two other survivors: Moon and Karen.
The game plays like a first person adventure game. It consists of a number of static environments that the player can move between and interact with a point and click interface. With the use of a cursor the player can click on any object on the screen. Doing so opens up a menu with four icons: an eye, a hand, a mouth and a rucksack. The eye is used to examine objects, the hand is used to interact, the mouth to talk or taste, and the rucksack opens the inventory. Action segments exist too. At times the player will come across monsters which need to be defeated. With the press of a button the cursor will then be transformed into a crosshair allowing the player to aim and shoot.