Heirloom jewelry boxes come in many different designs, but all are either considered worthy of holding other heirlooms or are so special as boxes that they themselves are heirlooms. Frequently, heirloom jewelry boxes are made of wood that has been decorated in some way, although it is possible to have boxes made of other materials. These boxes are usually small enough to be placed on a dresser or held in one's hand. The motif used to decorate the box may be personally relevant to the family or the first owner, or it may be more general. An heirloom box may become an heirloom for any number of reasons, including being possessed by an important family member, so there are no precise qualifications that make something an heirloom box.

Wooden heirloom jewelry boxes are probably the most common type of heirloom box. A wooden box may be decoratively carved with any number of designs limited only by the carver's skill. Figurines may be carved directly into the box, or it may be marked with more geometric designs. Even the shape of the box may be carved, making possible rounded or even spherical boxes. Inlaid wooden heirloom boxes are also popular, as are boxes made by other woodworking techniques.

It is also possible to make an heirloom jewelry box out of materials such as precious metals or stones. These can be very expensive and may themselves constitute heirlooms. When boxes made of less expensive materials are constructed in particularly fine ways by artists or craftsmen, those too may become heirlooms of independent merit.

Some heirloom boxes include elements that play music that may be hidden on the interior of the box. Typically, opening the box activates a mechanism that starts the music. Moving parts are very easy to break, so heirloom music boxes must be treated with special care.

The actual subjects portrayed on heirloom boxes may have a relation to a specific event or family tradition. For instance, an heirloom jewelry box might include a portrayal of a family shield or an animal associated with the family name. When a box commemorates an event, it might include a graphic representation of the event or simply the date. Commonly, the owner's name will be included in some way on the box, as these items are often custom made and can be personalized in any way.

An item may become an heirloom because it is made in a particularly fine fashion, but it may also become an heirloom because it is of historical or personal significance. If one's ancestor was an important historical figure, a common box owned by him or her might be considered an heirloom jewelry box. Alternatively, if one loved one's ancestor deeply, any item owned by him or her might be an important heirloom. Family possessions are deeply personal, and as such, any box might gain significance for one’s descendants and become an heirloom jewelry box.