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The painting is a version of a well-known composition: the Virgin and Child enthroned on a background of rich green drapery being crowned by two angels. In the left foreground, St James holds a stick, the classical sign of the pilgrim, with his knapsack next to him, while St Andrew on the right leans on the cross of martyrdom. Beside them and further back are two medical saints, Cosma and Damian, one of whom is holding a spatula and the other a pharmaceutical jar. The presence of these is due to the dedication of the altar, but there may also have been a personal meaning for Lotto. He was recovering from an illness between August and December 1546 when working on the altarpiece. Signs of this may perhaps also be found in the painting itself, with its simplification and poverty of inspiration, favouring the mystical moment typical of popular piety. The warm, luminous colouring, even if in subdued tones, has been recently brought back to light thanks to a masterful restoration.
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