The nave, chancel and apse of Andrarums kyrka originate in the twelfth century, when the church looked very different from today: the porch once stood where the sacristy now is, and the sacristy occupied the position now held by the font. There was originally no tower, the bell instead hanging in a freestanding belfry.
The church was extended northwards in the early 1700s with the addition of a second nave, known as the Verkakyrkan, and further altered later that century. Sources differ on some details of this building history: one account describes successive south transepts added in 1709 and 1768 with the tower following in 1817, while another places the north extension around 1700 and dates the present tower to 1830, replacing an earlier tower that reportedly collapsed while the great bell was being hung. A painting by Carl Johan Fahlcrantz is said to show the tower's mid-1830s appearance.
The bell in the tower today was a gift from Christina Piper in 1750, cast by Andreas Wetterholtz of Malmö; a smaller bell dates from 1868. Christina Piper, mistress of nearby Christinehof and owner of the Andrarum alum works, was a major patron of the church, funding the eastward extension of the chancel and a new altar in 1742 by the baroque sculptor Johan Jerling. She is also credited with donating the pulpit, and possibly a wooden font, in the same year, all attributed to Jerling's workshop. In gratitude for her financial support of the church's enlargement, the Piper family were permitted to install two burial vaults beneath the church, reached from the south porch.),
Jerling, regarded as the leading baroque woodcarver in Skåne, worked for nearly fifty years across the region and undertook further commissions for Piper at Christinehof's own chapel and elsewhere. His altarpiece for St Maria church in Ystad, commissioned in 1719, was apparently not completed until 1733.
A notable restoration in 1930 uncovered late-fifteenth-century ceiling paintings in the apse, attributed to the so-called Everlöv Master, depicting the evangelists Luke and John alongside a Last Judgement scene. A separate wall painting from 1619 records a list of parish priests. The church also contains a triumphal crucifix dated to the 1600s and a communion chalice said to date from 1606. The organ on the north gallery was built in 1879 by Salomon Molander & Co of Gothenburg, with a case designed by Otto August Mankell, and was renovated in 1999.