In Patchwork, 2 players compete to create the most aesthetic (and high-scoring) patchwork quilt on a personal 9x9 game board. To start, place out all of the patches at random in a circle and put a marker directly clockwise of the 2-1 patch. Each player gets five buttons — the money and points in the game.

Each turn a player either buys one of the three patches sitting clockwise of the spool or passes. To buy a patch, you pay the cost in buttons shown on the patch, move the spool to that patch's location in the circle, add the patch to your game board, then move your time token on the time track a number of spaces as shown on the patch. If your time token is behind or on top of a players token, then you get another turn. You might choose to pass on your turn; to do this, you move your time token to the space in front of the opponent's time token, then take one button from the bank for each space you moved.

In addition to a button cost and time cost, each patch also features 0-3 buttons, and when you place your time token past a button on the time track, you get "button income": sum the number of buttons depicted on your personal game board, then take this many buttons from the bank.

The time track depicts five 1x1 patches, and during setup you place five actual 1x1 patches on these spaces. Whoever first passes a patch on the time track gets this patch and plays it on his game board.

If you can completely fill in a 7x7 square on his game board first, gets a bonus tile worth 7 extra points at the end of the game.

When a player takes an action that moves his time token to the end of the time track, he gets one final button income from the bank. Once both players are at the end, the game ends and scoring takes place. Each player earns one point per button, then loses two points for each empty square on their game board.