The retrofit of a building involves not just the fulfillment of functional requirements, but also considerations such as investment costs, energy consumption, environmental impact, and occupant well-being. Careful long-term decisions in the retrofit and operation of buildings can significantly improve their thermal performance and thus reduce their consumption of energy. Moreover, they can improve indoor environmental quality in buildings. Alternative building energy conservation measures, standards compliance, and economic optimization can be evaluated using available energy analysis and decision-aid techniques. These may range from simplified energy analysis methods for approximate energy use estimates to detailed computerized hourly simulation coupled with decision-aid techniques. This chapter reviews the research and development in the decision support processes in building retrofit. Special attention is devoted to the methodologies using multi-objective optimization and genetic algorithms. Accordingly, the decision methodologies are broadly separated into two main categories: approaches in which alternatives are explicitly known a priori and approaches in which alternatives are implicitly defined by an optimization model. The advantages and drawbacks of the various methods in each category are also discussed.