We have stayed at Casa Madrona twice, and can highly recommend the hillside suites. We had lived in the area for years before staying here, and somehow got the impression from the outside of the hotel that it might be slightly tacky and run down. I don't know about the other kinds of rooms, but that is definitely not the case where we stayed. This is a "hidden" gem tucked up the side of the hill in Sausalito, and these rooms, while right downtown and convenient to every Sausalito attraction, have a fantastic view of the water with floor to ceiling windows and a balcony. They somehow create a sense of privacy and coziness (romantic!). Though just one large room, they are tastefully appointed, with a large upholstered chaise at the foot of the king bed, another chair and ottoman, two desks, a large bar, and entryway. The room feels light and spacious. The bathroom is sensational, very large with huge tub, double sinks, separate huge glass shower, and a luxurious feel. This hotel doesn't have it's own restaurant but is atop an Italian restaurant Poggio, and they serve room service to the hotel from 7am-10pm which worked great for us! There are a ton of fantastic eateries within walking distance, as well as the bay, the ferry to San Francisco, etc.
I did not use the in-hotel spa this trip but did last time, and can highly recommend it.
This boutique hotel has a lovely small lobby with friendly, gracious staff, a separate lounge area with computer and sitting area, and valet parking. I would say the only downside to the hillside rooms is the traffic noise, but that calms completely down at night as Sausalito attracts its action mostly during the day. All in all, for the money and compared to other more pricey hotels in the immediate area, Casa Madrona is a great find, and we will come back every year to our hillside room on the 4th floor!