In 1512, Cardinal Giovanni would return briefly to his city of birth after eighteen years of exile, and the Medici family would be restored to power. Pope Julius was dead and the College of Cardinals convened to elect a new pope in 1513. After seven days, the cardinals agreed. The newly-elected pope was the 37-year-old cardinal Giovanni De’Medici. He took the name Leo.

Leo continued where Pope Julius II left off in the construction of St. Peter’s Basilica. Construction of the old Basilica had begun under Constantine in the 4th century. It was neglected during the Avignon Papacy, until Nicolas V commenced repairs on the site. Julius II decided to tear it down and completely rebuild, starting in 1506. Major funding during Leo X’s papacy was through the sale of "St. Peter’s Indulgences."

The Basilica would not be completed until the early 17th century, its construction spanning the careers of 20 popes.