The interior climb is the thing people are most wrong about before they arrive. It is not a lighthouse spiral. The tower is ascended by a series of long, gently graded ramps with short flights of steps between them, and the effect is a steady walk rather than a stair workout.
Most reasonably mobile adults do it in ten to fifteen minutes at an unhurried pace, and plenty of people well into their eighties climb it. There are landings to stop at, each with an opening in the granite and a different view, so it is not a blind slog.
That said, it is 252 feet with no lift. Anyone with a serious heart or breathing condition should treat it as a genuine climb, and small children need supervision on the ramps rather than freedom.
Come in the first hour after opening or the last two before closing to avoid queueing on the ramps, which is the only way this climb becomes unpleasant — a August midday backlog on a narrow ramp in granite is warm and slow.
Opening dates, hours and ticket prices are set seasonally and the monument closes for part of the winter. Check the Pilgrim Monument and Provincetown Museum's own schedule before you go, and check the current state of the accessible approach from Bradford Street if that matters to you, because the hilltop is reached by a steep path.