The earliest version of Purcell's Thou know'st, Lord, the secrets of our hearts, Z. 58, dates from sometime before 1683, as does a revision of the piece. His first setting is a verse anthem for chorus only, while the second is also a verse anthem, but with the addition of solo soprano, alto, tenor, and bass.

The text is the third and final "sentence" from the Anglican Burial Service, the first two parts of which Purcell also set: Man that is born of a woman (Z. 27), and In the midst of life we are in death (Z. 17a, b). All of these are from The Book of Common Prayer of 1662. In Thou know'st, Lord, the narrators plea to their God, who knows all of their thoughts, to hear their prayers and not to forget them in death.

Like Purcell's settings of the first two sections of the Burial Service, that of Thou know'st, Lord is generally polyphonic. (This is the chief difference between the 1683 and 1695 settings of the text.) Falling intervals depict death and the general atmosphere is penitent. There is, however, a moment of brightness at "but spare us, Lord most holy, O God most mighty," in which the severity of the piece diminishes. The plaintive tone returns, however, as the narrators ask that, in death, they not "fall away from thee," and thus be condemned. The chorus repeats lines first sung by the soloists, but in a more powerful manner.

Purcell would assemble and re-work his settings of the Burial Service, including Thou know'st, Lord, for the Funeral Music for Queen Mary, performed at the Queen's funeral at Westminster Abbey on March 5, 1695. Thomas Tudway, a Chapel Royal Chorister, was present at the funeral and reported that Thou know'st, Lord was accompanied by "flat Mournfull Trumpets." These instruments, introduced into England only four years earlier by the Moravian composer Gottfried Finger, were also employed by Purcell in the March and Canzona, newly composed for the occasion. Featuring a slide that extends over the player's back (in the opposite direction of a trombone slide), the "flat" trumpet allows one to perform chromatic pitches not possible on the "natural" trumpet of Purcell's time. This make it possible to use the instruments in minor-key works. Most recordings of Thou know'st, Lord are of this last version, but few use genuine "flat" trumpets.

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