The significance of Tilshead in the 11th century as a borough, as well as a Royal manor, and the plan type of the present church, suggests the possibility that there was a church here in Saxon times. There are worked stones in the inner walls of the belfry stage of the tower which may have come from an earlier building and therefore support this theory and a rector was recorded c.1170. By the early 13th century the rectors were absentees and the church was served by vicars representing the rectors.
A vicarage had been ordained and by 1291 had been consolidated with the rectory. By 1317 the advowson had been given by Edward II to Ivychurch Priory with license to appropriate the church, until the time of the Dissolution, and then the Crown retained it until it was sold to the Bishop of Salisbury in 1902. In 1991 Tilshead became part of the benefice of Tilshead, Orcheston and Chitterne.
The vicar had a modest house from 1319. It was a three roomed residence in the late 16th century, with a thatched roof. By the 1820s the vicarage was a red brick house south west of the church and it was then replaced again in 1972, with a house in the High Street. In the late 18th century and early 19th centuries the vicars were pluralists, serving more than one church, and curates were appointed at Tilshead. One Sunday service was held at this time, as well as extra communion services for Christmas, Easter, Whitsuntide and Michaelmas.