Five experts ruled Tuesday that Guy Turcotte must stay detained for at least six more months, but will be allowed some escorted outings beginning immediately.
They said the trips can be suspended by hospital officials if Turcotte's mental state deteriorates or if public safety is threatened in a significant way.
The Crown and the facility wanted Turcotte to stay at the hospital for at least another year. Turcotte's lawyer argued he was ready to be released into the community.
But the mental-health panel decided neither solution fit Turcotte's case.
"The commission concludes that the accused remains very fragile," says the 17-page ruling.
"The evidence has not shown that (Turcotte) has acquired the skills necessary to meet the very great difficulties he will encounter during his rehabilitation."
Over the next three months, Turcotte will be allowed trips of up to eight hours a day while escorted by a family member. After 90 days, he will be able to leave the facility unescorted, moving gradually up to eight hours a day.
After five months, he will be allowed to leave unescorted up to 16 hours a day and can stay overnight with family members as long as they are with him.
Turcotte is also forbidden from having contact with his ex-wife, Isabelle Gaston, or her new partner, or be within 500 metres of their home or place of employment. Gaston has said she opposes his release and fears for her safety.
A new hearing for Turcotte has been scheduled for this December.
In February 2009, Turcotte stabbed five-year-old Olivier and three-year-old Anne-Sophie nearly four dozen times as they slept in their beds.
He admitted causing the deaths but denied intent. The Crown had charged him with two counts of first-degree murder, but a jury found him not criminally responsible, a verdict that sparked widespread public outcry.
Turcotte testified at his trial he was distraught over the breakup of his marriage and that he didn't remember committing the act.
Turcotte insisted in testimony he's fought off depression, is ready to confront an angry public and is looking forward to continuing therapy outside hospital walls.
But the experts determined there is no guarantee he would adapt well to the stress of everyday life.
"This great fragility and lack of means developed by the accused to counter it constitutes a real risk of relapse," the ruling states. "This risk is not hypothetical but rather well substantiated by the evidence."
A Crown spokesman in Quebec City says they'll look at the ruling before making any further comment.
Rene Verret said prosecutors have 15 days to appeal the decision.
The Crown has also said it's appealing the criminal verdict because it believes the judge erred in his instructions to the jury. The Quebec Court of Appeal has yet to rule on whether it will hear the case.
A former cardiologist, Turcotte gave up his right to be a doctor in 2009, according to the Quebec College of Physicians.
He has expressed an interest in working in medicine again.