The name comes from Old Welsh - lynn llaith cau, lake in the moist hollow - and originally referred only to the loch beside which the town grew up. The town itself was once called just 'Lithgow' (which is why the surname is so common in Scotland). The royal burgh developed in the Middle Ages around Linlithgow Palace, on a logical halt between Edinburgh to the east and Stirling to the west. The palace was begun in 1424 by James I, attacked by Cromwell in 1650, burnt accidentally in 1746 by the Duke of Cumberland's army, and remains - even roofless - what has been called Scotland's finest surviving late medieval secular building. James V was born here in 1512. Mary, Queen of Scots was born here in 1542. The hexagonal fountain in the palace courtyard still works.

A 17th-century English visitor named Thomas Kirk reported in 1679 that Linlithgow's coat of arms showed 'a black bitch tied to a tree, in a floating island.' He could find no story for it. A later legend filled the gap: a black greyhound's master was sentenced to starve to death on an island in the loch, and she swam from the town every day with food for him until she was caught and chained on a separate island to suffer the same fate. The townspeople took her loyalty as symbolic of their own, and those born in Linlithgow have called themselves 'black bitches' for centuries. In 2021 the Greene King pub chain announced plans to rename the historic Black Bitch pub on the grounds that the name had 'racist and offensive connotations.' Over 10,000 local residents signed a petition to keep it. The chain renamed it The Willow Tree anyway. The arguments continue.

In 1847 a Linlithgow-born chemist named David Waldie - by then working at the Liverpool Apothecaries' Hall - recommended chloroform as a potential anaesthetic to Sir James Young Simpson in Edinburgh, who popularised its use and changed surgical medicine forever. Waldie's family had run a chemist's shop on Linlithgow High Street; that building later became a restaurant and is today the Four Mary's pub, with a plaque recording the history. Linlithgow also claims Scotland's first petrol pump, installed in 1919 - again with a plaque. Other notable natives include the marine zoologist Sir Charles Wyville Thomson, chief scientist on the Challenger Expedition that essentially founded oceanography; John West, the Scottish-Canadian inventor whose Oregon tuna cannery created the John West brand still on supermarket shelves; and Alex Salmond, the former First Minister of Scotland, born in 1954 and raised here.

In September 2007 a plaque was installed in Linlithgow commemorating the future birth, in 2222, of Montgomery Scott - the fictional Chief Engineer of the starship Enterprise in Star Trek. Star Trek production materials and D.C. Fontana's novel Vulcan's Glory place Scotty's birth in Linlithgow - though Aberdeen also claims him, citing both the show's scripts and actor James Doohan's family. The town leaned into the recognition. Modern Linlithgow keeps a foot in both centuries: Oracle runs a major computing centre here, Calnex Solutions floated on the London AIM market in 2020, and the Linlithgow Union Canal Society runs narrowboat tours from Manse Road basin on the Union Canal, which arrived in the 1820s and helped industrialise the town. The annual Party at the Palace music festival has brought Nile Rodgers, Simple Minds, The Proclaimers, and Deacon Blue to play beside the loch. The Black Bitch still appears on the coat of arms.