Mark Twain National Forest was established by President Roosevelt by proclamation on September 11, 1939. The metal lookout tower was erected in 1953-54 and the cab was refinished in 1969-70.
In August 2023, a visit to the tower showed the tower and cab remain standing, though they are in poor shape (especially the cab). The base of the lookout tower has a chain link fence around it with barbed wire on top.
There was at least one other Pilot Knob Lookout in Missouri in Stone County.