This investigation analyzed the energy efficiency of a steam system in a hospital, considering the procedure in ASME EA-3-2009 standard. The obtained boiler energy efficiency was 80.29 %, by applying an energy balance, reaching 15.33 kW for heat losses in the distribution pipes. Two consistent improvement alternatives were proposed, starting by unifying the pipe diameter of the kitchen area of 5 m, generating a reduction of heat loss from 828 to 600 W, which represented a total annual energy saving of around 2.4 GJ/year. The investment cost is USD 47.40, considering the achievement of the break-even point after 9 months, where the insulation of the pipes with glass wool was considered second and it generated a reduction in losses of 5.98 kW, representing a total annual energy saving of about 62.91 GJ/year, which corresponds to approximately USD 1,672. The investment for pipe insulation with a length of 49 m was USD 462, considering the NPV calculation and the possible savings, and the break-even point was reached after approximately 4 months, indicating the economic benefit of applying the two improvement options proposed.