The church is built of stone and brick, with a rectangular nave, a chancel to the east and a sacristy attached beyond it. A tower rises at the western end, topped by a low cupola and marked by sturdy buttresses and a timber gable feature. The exact date of the original building is uncertain, but it is thought to date from the 1200s or 1300s, with later medieval extensions.
A major rebuilding between 1801 and 1803 gave the church its present neoclassical appearance. At this time the porch and medieval vaults were demolished, while the tower and sacristy were newly built. The tower suffered from subsidence soon afterwards and was not completed until 1832; the interior was also restored and a round window opened in the east wall during this period. Further changes to the fixed fittings were made during a restoration in 1929.
Among the older furnishings is a font dating from the 1200s, fragments of a medieval altar cabinet, and a triumphal crucifix from the 1400s. The church also holds notable ecclesiastical textiles, including a chasuble associated with the workshop of Albertus Pictor and a finely embroidered cross thought to be of German origin, once mounted on a medieval chasuble. The pulpit was acquired in 1674, though it has reportedly been dismantled and reassembled more than once over the centuries, so parts of the original survive within a later structure.
The church organ has a particularly long history. It was originally built around 1650 by the organ builder Nils Bruce, and was moved to Åkerby from Tierps kyrka in 1745, when it was reinstalled by Carl and Anders Holm of Uppsala. The instrument's case dates from the same period as the organ itself. It has since been altered and restored several times, including changes to its stops in the 18th century and renovations in the 19th and 20th centuries.
The church's two bells, in the tower, sound the notes F sharp and B, according to Wikipedia.