Hard Mode causes various effects that change the gameplay of Granny. These include:
- Granny moving a bit faster than usual, but is still slower than the Player.
- Granny is knocked out for 30 seconds with Tranquilizer Darts, the Sauna, and the Car.
- 6 Locks on the Main Door: Bottom Plank, Wire Lock, Wooden Padlock, Number Padlock, and Battery Lock.
- No opportunity to complete the Painting.