Richly decorated Ketubot can be found in the great museums of the world from Persia, Italy, Turkey and even the United States. The design of a ketubah would often reflect the style of the times, and could include symbols of the country such as flags or crowns. Jewish symbols were also prevalent - the lions of Judah can often be seen in historical Ketubot as well as Hebrew calligraphy in stylized forms. Modern Ketubah texts have followed social convention in creating equality between Bride and Groom in terms the exchange of vows. Some texts duplicate the wording for each spouse and others simply leave out all monetary consideration.
Some rabbis allow the couple to add to the text or to devise their own texts.
This practice keeps with a tradition in which a Ketubah would include family history, achievement and lineage as part of the design. In general, as all Jewish ritual has evolved to suit the times, so too has the Ketubah evolved in text and design. The practice of commissioning custom Ketubot came into vogue in the 1960's along with a general interest in rediscovering Judaism. Many parents who had printed Ketuboth from the Rabbi would shop with sons or daughters for highly priced original works of art. Soon a vast number of prints, some in limited editions, began to appear, making the choice of a Ketubah a daunting task.