The current building maintenance practices in Palestine are not based on scientific systematic methods. Most of the municipalities use one criterion to define the maintenance priorities, which is the “worst-first” criterion. Therefore, the current practices in defining buildings maintenance plans are not dealing with the known phases that are generally followed, including those in establishing building inventories, building condition survey, detailed visual inspection, identification of the proper maintenance and rehabilitation measures, and setting priorities. Accordingly, the recent preparation of the Operation and Maintenance (O&M) Manual for Palestinian municipalities is an important step to guide them towards preparing and implementing their O&M priority-based plans, considering scare resources. During the course of preparation of the Manual, the proposed procedures were applied at ten pilot municipalities. This study aims to explore the outcome of the implementation of the 2014/2015 O&M buildings maintenance priorities at these municipalities through the development of maintenance composite priority index (PI). The new proposed priority index is a scientific tool that will identify the priority of maintenance buildings through using a systematic procedure instead of first worst one. To achieve this, analyses of the outcome of a questionnaire designed to collect relevant information from these municipalities was conducted. The maintenance priority index for buildings is calculated considering different indicators among them building status (condition), classification and importance of the building, number of beneficiaries (users), safety aspects (severity level in the building), and people complaints. The main component of the PI is the building condition index (BCI) which forms about 40% of the total weight. The physical inspection, which is the main input for calculating the BCI, is conducted on two levels; the primary level, and the secondary level. The buildings are ranked in descending order based on the PI values for each public building. The buildings that have the highest values of PI take the most priority till the specified asset maintenance budget for the targeted year is achieved. Finally, the results indicate that most of the maintenance works are funded by municipalities own budgets and not by the government.