The design of the vestment for sisters of mercy of the Marfo-Mariinsky Convent was created by Grand Duchess Elizabeth Feodorovna. She thought it appropriate to abandon the black that was common among nuns and chose dark gray as the new basic color. This was the Grand Duchess’s way to highlight that the service of the sisters of charity of the Marfo-Mariinsky Convent was different from that of nuns: the essence of the veil is about the service of God through private devotion and alienation from the world, while the sisters went out into the world to help those in need. They tended to the sick and the poor and taught at the Sunday school.

Marfo-Mariinsky Convent had an outpatient clinic and a hospital that was admittedly an exemplary one. The sisters were trained in medicine and psychology. The best doctors of Moscow lectured them, and spiritual fathers talked to them. When the word spread of the exceptional care offered to patients at the convent, Moscow started sending patients in a grave condition to the Convent to have them placed under the care of the sisters. 

During World War I, she extended immense support to the Russian army and wounded soldiers. May fighters lost their limbs and were disabled, but Russian doctors then rarely offered prosthetics. A year into the war, a prosthetic workshop was set up with the money raised by Elizabeth Feodorovna, among others.