Cotten wrote most of her music in her early teens and earlier (she wrote "Freight Train" at age 11). After marrying at 15 and getting work as a maid she stopped playing music for 40 years. It wasn't until she was working as a maid for Charles Seeger, an avid music lover, that she relearned how to play the guitar.
In the 1950s Mike Seeger began to record Cotten on reel to reel tape. In 1960 she began to play live for the first time, her first show was with Mike Seeger and she went on to perform with musicians such as Mississippi John Hurt, John Lee Hooker, and Muddy Waters. Because of the positive reaction Cotten began to write, record and tour with new material which she continued to do into her 80s. In 1984 she won the Grammy "Best Ethnic or Traditional Recording" for the album Elizabeth Cotten - Live!.
Elizabeth died when she was 92 in Syracuse, New York.