What applies to the design of the oldest incunabula also applies in general to their decoration and illustration: the hand-written book served as a model. Sometimes the initials and rubrics were not even printed but added later by hand. The invention of printing did not initially bring to an end the ancient art of illumination. Manuscript illumination even flourished in the Low Countries around 1500 with the work of the 'Ghent-Bruges school'.

The block-book, the pre-eminent example of the late medieval picture book, was also strongly dependent on the manuscript tradition, for example in the choice of subjects depicted. Nevertheless, the changeover from miniature to woodcut had far-reaching consequences. From an artistic point of view, the block-book attained its peak in the Northern Netherlands between 1460 and 1470. Works printed here, such as the Biblia pauperum, contained monumental woodcuts, strongly linear in character, with strong contours and limited hatching. The illustrations in the early incunabula show the same form although the monumentalism of the block-book woodcuts is often missing and the inner detail even more frugal. Particularly fanciful and lively are the woodcuts in the Twespraec der creaturen by Gheraert Leeu (Gouda, 1481).

Of the almost 2200 known Dutch incunabula editions, 40% is illustrated using one or more woodcuts, totalling more than 3800 different prints used in about 12,000 places. From the beginning the illustration of books involved repetition and imitation, a phenomenon that would continue for centuries. A series of illustrations was seldom used exclusively for the edition for which it was originally intended. Successful woodcuts were copied by others as soon as they appeared. Piracy in the field of book illustration was rampant as well.

During the sixteenth century, alongside the traditionally domineering illustrations of religious books, an increase in 'scientific' illustrations could be seen. Scholarly literature and legal texts were, it is true, not illustrated, but works in the fields of anatomy, biology and medicine were, often profusely. There was a penchant for illustrations of monuments, inscriptions and coins from antiquity. Typical products of the Renaissance and Humanism were the illustrated architectural treatises and emblem books. This period also brought much modernisation of form such as the title page, decorated with ornamental borders, allegorical representations or portrait medallions. Trailing vines, grotesques and architectural motifs were often used as book decoration. New ornaments were, among others, arabesques, mauresques and scrollwork grotesques.

Many of these innovations first appeared in the Netherlands in Antwerp which, in the sixteenth century, became the predominant centre. Here, for example, appeared 80% of all bibles illustrated in the Netherlands. Printing centres in the Northern Netherlands, such as Gouda, Delft and Haarlem, which prior to 1500 together with Antwerp and Louvain, had played a leading role in the field of book illustration, could offer little in the way of competition. The exceptions were Leiden and Amsterdam where printers occasionally made use of prominent artists. In Leiden the publications of Jan Seversz. deserve recognition, especially the prestigious Missale Traiectense (1514), with woodcuts by Lucas van Leyden and others. The designs for the illustrations of the Amsterdam printer, Doen Pietersz., for, among other things, his Passio domini nostri (1523), were mostly supplied by Jacob Cornelisz. van Oostsanen.

Around the middle of the sixteenth century, most publishers from the Northern Netherlands were, as far as their illustrations were concerned, satisfied with copies or imitations of models from Antwerp or Germany, which did not necessarily imply an impediment to commercial success. Only in the last decades of the century did an artistic revival take place. This coincided with the arrival of immigrants of whom Christopher Plantin was the most eminent. Plantin, who, between 1583 and 1585, established himself in Leiden, can be seen as the major innovator of book illustrations of his time. His most important achievement in this field was the introduction of the copper engraving to illustrate books, which he gradually introduced from 1559/1562. This engraving technique, however, had the disadvantage that two press runs were now necessary: one for the illustration and one for the text. Plantin, however, saw the particular advantages of engraving: the finer lines and hatching made more accurate modelling and greater tonality possible. The typographical and artistic innovations of Plantin are clearly visible in the Coornhert edition of 1585 (printed in Leiden) with engravings by Jan Wierix.

Coornhert's emblem book was a de luxe edition for prosperous buyers. The same applies, paradoxically enough, to the late medieval Biblia pauperum, the 'bible of the poor'. Although it is traditionally assumed that the more pictures a book had, the more suitable it was for those who could hardly read or not at all, illustrations made a book significantly more expensive and, because of this, it in fact became less accessible to the illiterate who usually came from the poorer part of the population.