Cox was born March 19, 1963 in Edmonton, Alberta, to a ballerina Canadian mother and Linguist English father, Cox was educated locally, except for periods when his father's work led the family to postings in Nigeria, Chad and Cameroon. Cox eventually graduated from school in Edmonton Canada and moved to Toronto on his own when he was 17.

During his time as a student in London, Cox probably spent as much time in nightclubs as he did studying. Through his partying Cox became friends with several well-known designers, such as the legendary Vivienne Westwood. As a result, in 1984, Westwood asked Cox to design shoes for her "Clint Eastwood" collection. One of the shoes that Cox created incorporated a 4-inch platform that would become the prototype of a 9-inch pair later worn by supermodel Naomi Campbell, when she famously fell during a Westwood fashion show in Paris, France in 1993. In his second year of college Cox designed and handmade fluorescent fringed moccasins for the celebrated Body Map brand of David Holah and Stevie Stewart.

Cox set up his own company designing shoes in 1985, and in 1986 designed the shoes for John Galliano's "Fallen Angels" collection. Subsequently, Cox launched his own Patrick Cox label, adopting the fleur-de-lys logo. Cox continued to work with Galliano for a further six seasons. He also produced the shoes for numerous designers' fashion shows including Anna Sui, John Flett, Alistair Blair and Lanvin Haute Couture to name but a few.

In 1991 Cox opened his first shop opposite the Peter Jones department store in Sloane Square, Chelsea, a well-known fashion district of London. In 1993, Cox marketed his first collection designed for the mass market. This diffusion range called "Wannabe" increased the company's semi annual sales from 2000 to 200,000 pairs. Cox has credited his initial interest in moccasins to fellow designer Richard James whom had asked Cox to design him a modern loafer to accessorise one of his early 1990's fashion shows.

In 1994, Cox opened his first Parisian store on the right bank, followed in 1995 by a second store in London on Sloane Street, a new store on New York's Madison Avenue and a second store in Paris on the left bank. During this time, Cox was twice awarded Accessory Designer of the Year at the British Fashion Awards. 1998 saw Cox move his design office and production from the UK to Civitanova, in the Italian Marche, an area known for shoe manufacture.

From his early association with Vivienne Westwood onwards Cox developed a cult like status in Japan and in 1996 signed a 10-year licensing deal with the leading Japanese luxury department store group Isetan. This deal saw the opening of more than 40 shop in shops across Japan and a whole range of licensed Japanese product including ready to wear, bags, jewellery and watches.

Cox used to date Canadian Journalist, Entrepreneur, and magazine publisher Tyler Brûlé. Cox funded the launch of Brule's Wallpaper magazine that was subsequently sold to Time Warner in 1997. They split up in 1997.

At the age of 19, Cox produced his first pair of shoes, for the Toronto-based designer Loucas Kleanthous, who suggested Cox consider a career as a designer. An interest in British fashion led Cox to study at Cordwainer's Technical College, London, a design school that was absorbed into the London College of Fashion in 2000. Cox studied at Cordwainer's from 1983 to 1985. He graduated with merit in July 1985.

Cox was approached by the French fashion footwear house Charles Jourdan, and in January 2003 he was appointed Creative Director, his brief being to rejuvenate the brand. After 3 years of successful collaboration, Cox decided to move on to concentrate on the development of his own label.

The Hong Kong duty free company King Power Group took a controlling interest in the Patrick Cox company in 2006. Cox left his eponymous the following year and the entire Business, except for a few continuing Japanese licenses was closed in 2008.

In September 2010, Cox opened 'Cox Cookies & Cake', a pâtisserie in London's Soho district, with Eric Lanlard to whom he was introduced by Elizabeth Hurley. In keeping with the area's history of seedy Business, the décor was black and neon while the staff wore studded leather aprons. Delicacies included titty and bum cupcakes along with his mother Maureen's recipe for traditional Canadian Nanaimo bars. After 2 successful years trading Cox decided to close the Business to return to shoe design.

In 2011 Cox was approached to design for the Italian shoe giantGeox. The resulting GEOX Designed by Patrick Cox capsule collection perfectly incorporates his witty ironic British take on design with their leading edge Italian Technology. This collaboration continues successfully in its 4th year.

For Autumn/Winter 2016 Cox returns to fashion with his Lathbridge collection of shoes and leather goods. The brand name is Cox' middle name and the company logo is the bulldog inspired by Cox' much loved 2 English bulldogs Caesar and Brutus.