The church's core, the chancel and parts of the transept walls, dates from the medieval period, though experts have disagreed on exactly when. Early 20th-century scholar Lars Tynell dated the font to the mid-or-late 1100s and assumed the church was of similar age, a view later supported by Otto Rydbeck. More recent research suggests a 13th-century date instead, so the church's true age remains disputed. Some accounts also mention an earlier wooden church said to have stood on the site, possibly as early as the 1000s, though this cannot be confirmed.
The Scanian War left the church badly damaged, with its walls shot through and its furnishings and possessions largely destroyed. Repairs followed, notably a major restoration in 1727 to the roof and walls. In the 1850s the medieval tower was demolished and the building extended by around eight metres to the west, with enlarged windows and a new entrance; a replacement tower, designed by Oscar Ericsson, was added in 1877. A new porch was built in 1975 on the site of the earlier, ruined one.
In the mid-19th century the church faced a serious threat of closure. Plans were drawn up to merge Säby's congregation with the neighbouring church at Härslöv, partly to ease the burden of maintaining Säby's decaying building and partly, according to one account, for the convenience of the local provost. The architect Carl Georg Brunius inspected the church in 1845 and reportedly described it as an unusually poor and dilapidated house of God. A vote went against the Säby parishioners, and the merger was approved by both church and civil authorities. In response, the villagers appealed directly to the King, offering to fund the necessary repairs themselves rather than see the church demolished — an appeal that succeeded in saving the building.
The font, carved from sandstone and attributed to the medieval stonemason Tove or one of his pupils, is considered the church's oldest and most historically significant possession, related to a font at Källs-Nöbbelöv. During a restoration in 1902 its upper two-thirds were cut away, though no explanation for this survives. The altar painting, showing Mary beside the crucified Christ, was completed in 1925 by Georg Hansen of Landskrona. An altar carpet with a green background, embroidered in 1938 by members of the local women's sewing circle with their initials worked into the design, is valued by parishioners and reportedly influenced the layout of the chancel during a 1978 restoration.
The churchyard contains around a hundred graves, including a number recognised as being of cultural-historical interest, among them several members of the Tranchell family.