The oldest part of the building, the nave, dates from the twelfth century, making Siene one of the older surviving church structures in the area. In 1788 the medieval triumphal arch was removed and the church was extended with a three-sided chancel, along with a sacristy to the north, giving the building its current outline. A porch was rebuilt in 1942, moving the entrance from the south side to the west.
The most striking survival from the Romanesque period is a weathered sandstone tympanum built into the south wall, thought once to have stood above the main portal. Its carved scene, showing a woman attacked by snakes and flanked by two men, is generally read as a depiction of lust being punished in hell — a motif that appears elsewhere in Västergötland, notably at Strö church, and has parallels in twelfth-century French carving. Because of its current position the tympanum is not easy to see, and centuries of exposure to weather have worn its detail. An eighteenth-century memorial tablet is set into the wall just below it.
Inside, the church has a coherent Baroque character, with a panelled board vault typical of the period and whitewashed walls beneath a grey-blue painted timber ceiling. The altar is thought to be medieval, built of grey stone with a wooden top, while the altarpiece, dated 1752, retains the form of a medieval winged shrine, with a Calvary group at its centre and painted panels of prophets and evangelists on the doors. The pulpit dates from 1636 and is considered a fine example of Renaissance woodcarving; its sounding board was added in 1717 by the sought-after Borås sculptor Gustaf Kihlman, and an hourglass used to time services still survives alongside it.
The font, carved from sandstone in the early 1200s, belongs to a plain, undecorated type sometimes referred to as the Siene type, found elsewhere in the region. A wooden triumphal crucifix from the fifteenth century also survives. The pew fittings with their doors, along with the interior colour scheme, date only from a 1941 restoration overseen by the architect Ärland Noreen, giving the church its present unified appearance despite the age of its individual furnishings.
A red-painted detached bell tower from 1755 stands southeast of the church, housing a single late-medieval bell without inscriptions. The church's earlier organ, built in 1855 for the Paris World Exhibition and later used for decades in a Stockholm hospital, was acquired by the parish in 1895 and eventually replaced; the current organ was built in 1981, retaining the silent 1940s facade designed by Noreen.