The Order of St. John's biggest leap forward came in 1888, when Queen Victoria granted the society a royal charter, yet again renaming the order, this time as the "Grand Priory of the Order of the Hospital of Saint John of Jerusalem in England". This was altered in 1926 to the "Grand Priory in the British Realm of the Venerable Order of the Hospital of Saint John of Jerusalem", and then in 1936 as the "Grand Priory in the British Realm of the Most Venerable Order of the Hospital of Saint John of Jerusalem". In 1961 it played a role in the establishment of the Alliance of the Orders of St. John of Jerusalem, and thereafter finally received through a concordat in 1963 collateral recognition by the Order of Malta. The most recent royal charter was issued in 1955, with a supplemental charter released in 1974, recognizing the world-wide scope of the organization by setting its present name. In 1999, the order was granted special consultative status with the United Nations Economic and Social Council.
The reigning monarch of each of the Commonwealth realms is the Sovereign Head of the Order of St. John
Knights and Dames receive the award from the Grand Prior when they are touched on the shoulder with a sword and are given their robes and insignia. Post-nominal letters of the order are not used outside the organization itself, and a Knight and Dame may not use the prefix "sir" or "dame", though they may request from their local heraldic authority a personal coats of arms, should they not already possess any, and have it adorned with emblems of the Order of St. John. Further, membership in the order only grants precedence within the society, which is as follows:
Precedence within each grade is dictated by dates of appointment, save for those in Grade I who are either a head of state or a member of the royal family of a Commonwealth realm, another Commonwealth country, or foreign state, in which case they all precede the other members of the grade in the following order:
Following constitutional changes made in 1999, the Priory of England and The Islands was established (including the Commandery of Ards in Northern Ireland) alongside the existing Priories of Wales, Scotland, Canada, Australia (including the Commandery of Western Australia), New Zealand, South Africa, and, since 1996, the United States, each of which is governed by a Prior and a Priory Chapter. Commanderies, governed by a Knight or Dame Commander and a Commandery Chapter, may exist within or wholly or partly without the territory of a Priory, known as Dependent or Independent Commanderies, respectively. Any country without a Priory or Commandery of its own is assumed into the "home priory" of England and The Islands, many of these being smaller Commonwealth of Nations states in which the order has only a minor presence.
The Order of St. John is said to have arrived in Canada in 1648, as the second Governor of New France, Charles de Montmagny, was a member of the original order, but it was not until 1883 that the first branch of the modern organization was established in the country, at Quebec City, growing to 12 branches by 1892. The Order of St. John today forms part of the Canadian national honours system, and the Priory, established in 1946 out of the Commandery of Canada, is the largest outside of the United Kingdom, with some 6,000 members. The Canadian monarch's viceroy, the governor general, serves as the Prior and Chief Officer in Canada, while the provincial viceroys the lieutenant governors act as the Vice-Priors, overseeing the administration of the order in their respective province. These individuals thus automatically become Knights or Dames of Justice or Grace upon their swearing-into viceregal office.
An American Society of the Order of St. John was established in 1957 as a foundation to assist the order with charitable work, after 1961 focusing its efforts specifically on the St. John Ophthalmic Hospital in Jerusalem and some other organizations aiding the sick. This branch was successful enough that Queen Elizabeth II in 1996 officially created the Priory of the United States of America, the seventh priory at the time, with John R. Drexel as the first Prior. By late 2000, the US priory had approximately 1,100 members. As citizens of a country that did not have the sovereignty of the Order of St. John vested in its head of state, American inductees who first joined the new Priory were specifically asked to only "pay due obedience" to the governing authorities of the order "in all things consistent with your duty to your own country," thus eliminating any question of loyalty to a foreign head of state superseding American postulants' duties as US citizens.
Upon admission into the Order of St. John, confrères are gifted various insignia of the organization, each level and office being represented by different emblems and robes for wear at important occasions for the order. Common for all members except Esquires is the badge, consisting of an eight-pointed Maltese cross embellished in the four principal angles alternately with two lions passant guardant and two unicorns passant. That for the Sovereign Head is gold with arms of white enamel and the embellishments rendered in gold, all surmounted by a jeweled St. Edward's Crown, while those for the officers of the order are the same save for the Grand Prior's having the crown made only of gold; the Lord Prior's having in place of the St. Edward's Crown the coronet in gold of Albert Edward, Prince of Wales; and the Prelate's having instead a representation of a Mitre in gold. Thereafter, the badges are prescribed as follows:
All Bailiffs and Dames Grand Cross may wear their badges either at the left hip on a (for men) or (for women) wide, black watered silk ribbon over the right shoulder or from a wide black band at the collar. Male Knights Justice or Grace must carry their badges on a 16.5mm wide ribbon at the neck, and Commanders, Officers, and Members have theirs on a straight ribbon suspended from a medal bar on the left breast, while females in all grades may wear their insignia either on a ribbon bow pinned at the left shoulder or hung from a medal bar in the men's fashion, depending on the circumstance and clothing worn. Bailiffs and Dames Grand Cross, Knights and Dames of Justice or Grace, and Chaplains may all also wear a breast star, which appears the same as their badges, only at a diameter of and without embellishments for those in Grade I and for those in Grade II. Further, those in these groups are also given a button for wear on the lapel of non-formal civilian clothing, for events such as business meetings of the order. In general, the insignia of the Order of St. John may be worn at all occasions where other decorations are worn, not only those connected with the ceremonies of the order.