Helleborus foetidus prefers consistently moist, but not waterlogged, soil. Water regularly during dry spells, especially in its first year after planting, to establish a strong root system. Reduce watering once established, as it tolerates some drought, but avoid prolonged dryness which can stress the plant. Ensure good drainage to prevent root rot.

Minimal pruning is required for Stinking Hellebore. Remove any damaged, diseased, or yellowing leaves at the base of the plant to maintain a tidy appearance and improve air circulation. Spent flower stalks can be cut back after flowering if self-seeding is not desired, otherwise, leave them to mature seeds.

Helleborus foetidus can be propagated by seed, which often self-sows readily around the parent plant. Collect seeds when ripe and sow immediately, as they require a period of cold stratification to germinate. Division of mature clumps is generally not recommended as hellebores resent root disturbance.

Helleborus foetidus is best grown in the ground and does not typically require repotting as it resents root disturbance. If grown in a container, choose a large pot to accommodate its mature size and only repot when absolutely necessary, carefully transferring the entire root ball to a slightly larger container with minimal disruption.