Silent Hill 2 is not a direct sequel to the events and characters of the first Silent Hill game. Instead, it centers on James Sunderland, who enters the town after receiving a letter written by his deceased wife, saying she is waiting for him in their "special place" in Silent Hill. Joined by Maria who resembles her except for a more provocative outfit and personality, he searches for her and discovers the truth about her death. Additional material in re-releases and ports included Born from a Wish, a sub-scenario which focuses on Maria before she and James meet.

Silent Hill 2 uses a third-person perspective and gameplay places a greater emphasis on finding items and solving riddles than combat, similar to the first Silent Hill. Psychological aspects such as the gradual disappearance of Mary's letter were added to the game. More humanoid than their counterparts in the preceding game, some of the monsters were designed as a reflection of James' subconscious. Real-life references to history, films and literary works can also be found in the game.

An updated port of the Playstation 2 hit Silent Hill 2, the Xbox version includes the additional bonus content featured in the Greatest Hits version of Silent Hill 2, the new Maria scenario, that can be played separate from the main game. It is playable via backwards compatibility with a hard drive equipped Xbox 360, but with several graphical glitches and issues that distract from the experience.