Securing land rights and the rationalisation of the debate on formalisation of land rights through titling have been the focus of many scholars for some time now. At least, there is consensus among most scholars that land registration is one of the ways of addressing these issues and that current land registration system in most developing countries needs reforms. This paper examines the design and implementation processes of land registration reforms in Ghana. Using the Greater Accra Regional Lands Commission as a case study and institutional design theories, the article analysed how land registration reforms were design and implemented. The paper shows that the design strategies for the reforms were harmonisation of policies and laws and organisation restructuring at the organisational and process levels, but staff resistance to change led to implementation flaws. The paper recommends that institution design of land registration reforms must be combined with the theory of change where all staff are taken through the new organisation’s work ethics and attitudinal change processes adequately.