Sandanski is an ancient town with vast history. Underneath modern Sandanski are the ruins of an old city, which was established close to the mineral springs already in the second century B.C. From the Thracian tribe “MEDI”, which populated this region, originated the famous Spartakus – the leader of the largest upriot (74 A.D.) in the Roman Empire. Up to the sixth century A.D. the town was one of the first centres of Christianity in Bulgaria, but in the of the same century, it was entirely destroyed by barbaric invaders. Archeological sites in the centre of town testify to the fact, that the ancient town underneath has been built in 3 stages, in 3 different periods. The settlement established by the Thracians was named “Medius” /meaning "in the middle" of the 3 mountains – Pirin, Ograzhen and Ali Botush/. Later the Romans called it “Dezudava”, and the Slavs tribes, which came here later, renamed the settlement into "Sv.Vratch" in memory of the brothers Kozma and Damian – famous healers.

Sv.Vratch was renamed into Sandanski in 1947 – honouring the Bulgarian revolutionary Yane Sandanski, who fought for the liberation of Bulgaria from Ottoman rule. Bulgaria was liberated in 1878, while it's southwestern parts including Sandanski - in 1913.