I like to start with the most difficult or expensive item and that seems to be the countertop. Looks like a standard size cabinet so I would start with the countertop. Maybe find a deal. Then paint the cabinet a color that works with floor and counter.

If I do replace the counter, it would just be another cream or off-white, but with a more up-to-date shape. So, that won't really give me a good jumping-off point for actually decorating the space.

Usually people use wallpaper, tile or wainscot to add interest to powder rooms. If you're keeping the floor and the vanity and can't use wallpaper you have boxed yourself into a corner. Maybe other creative people will be able to come up with ideas, but I think I would replace the vanity entirely and like you said, replace the mirror and light fixture. The vanity you have is so dowdy. The floor isn't terrible - it looks like a pretty neutral beige. You can always put down a rug. Then you can paint the room an interesting color and you'll have something much nicer than what you have. The mirror in the first picture is too ornate for my taste, but here are two ideas.

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Have the walls skim coated and use any wallpaper you want!

I had that done in my previous house for a large master bedroom and my walls were much more textured than yours.

Here's what I would do if it were mine: new vanity/countertop and a pretty mirror with a pretty frame. If you really want wallpaper, you can have the walls skim coated. If you're so-so about wallpaper just paint it a lovely color -- a jewel tone and a chandelier (nix the vanity light unless someone uses it to do their makeup) and it becomes a jewel box. I don't think you need to change the flooring, but I would change the vanity and mirror for sure.

Personally I like a crisp white or near white stone or quartz countertop. My love is marble, but that may or may not be ideal for you (depending on how rough the users are with the bathroom).

allen + roth marble countertop and undermount sink

I also prefer wide spread faucets instead of the builder basic ones. Not certain what finish color you liked. I personally prefer a brushed nickel, but maybe you'd prefer brass or something else.

Moen Banbury high arc faucet

If I used this rug for inspiration would this work or is it too out there?

Round black framed mirror, black iron lighting, the deep green color for the vanity with black hardware ...

Not sure what I would do with the walls or even what art would work.

Thank you, @BeverlyFLADeziner . In my comment, I said I was thinking of painting the vanity a deep green. If I used green on the walls, what color would be good for the vanity?

Maybe match the vanity to the background color of the rug?

I was trying not to make everything in the room dark. The rest of the house has light floors and light walls, I think the difference might be too jarring. Also, I'm a little claustrophobic, the fancy cave look makes me uncomfortable.

Perhaps a green vanity and bold art with a black frame on the wall?

Ad dark powder room can be a pleasant contrast to the rest of the home.

That is about as bland as bland can be.

But the good thing is that it's a nice canvas for whatever theme /color scheme you choose ... and a powder room is small enough to be easy /quick to decorate.

I have the first cousin of your bathroom. I have been referring to it as "the coffin" due to the narrow feel and the 10' ceilings. I have been looked at wainscoting - placed at least 5-6' high - to counterbalance the ridiculous ceilings. A darker color above and light color below might work with your Arts and Crafts rug. Or the reverse?

I like @BeverlyFLADeziner's color choice.

Inspiration for what color to make the vanity might follow the first step. Changing it to something open like her last dark grey bathroom photos help to reduce the claustrophobia. Note the open custom vanity in the first photo.

I like the higher beadboard in the second photo for our "tall and narrow" rooms.

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That is all builders grade - the lighting, mirror, vanity and sink. I'd replace it all.

Yes, I realize much of it needs to be replaced. I was asking for specific suggestions.

Have you searched pictures on Houzz? If not, go to the top to the search box and type powder rooms. Then click on the word “pictures”. Start saving the ones that attract you and you will soon find a theme. That’s how I discovered I was always drawn to a certain color and look for a room I was repainting. Analyze the pictures you saved to find the details that appeal to you.

I think you’re on the right track with the rug as an inspiration. Great colors.

I discovered this site that does vintage-look floorcloths using vinyl and now I have too much inspiration! Has anyone ordered from Spicher?

I would paint the ceiling and down the walls to 8 ft. a dark Navy (SW Naval) the bottom SW Alabaster, with no natural window light it will look more tan, might compliment the existing sink/top.

and hang a beautiful light fixture. Even if you don't have an electrical box.

I personally would work with what is there. Paint the vanity Base a color you love... a deep teal? find a rug or painted floor cloth that you love to see when the door is open.

hang something personal on the solid wall... a piece of art you have, but don't want to hang it anywhere else in you house... even a grouping.

I really like that last rug you posted. The colors complement your wood vanity. I love that inspiration photo RedRyder posted. You can get a similar look by applying wall mouding and paint, even without paneling. I’d use the rug as inspiration for wall colors. The dark green paint is from Benjamin Moore.

I like the first rug from Beverly. The deep tones of the Arts and Crafts work with your vanity. As @ffpalms indicated, we can “cheat” the paneling by just using vertical panels spaced properly.

I do love that dark, dark green for a little bathroom.

To all the pros: with narrow but super tall powder rooms, if using the paneling idea, does the dark color go on top- including the ceiling - to help “bring it down” visually? Is doing the ceiling darker bringing attention to it? @ BeverlyFLADenziner? @ffpalms?

I’m not a pro, but I have heard that dark colors should go on the bottom. When I went looking for confirmation of that in bathroom photos, I found more examples of dark colors on top. Maybe because they are such small rooms, people prefer the dominant color to be light. Here are a few photos to help decide which you prefer.

This last photo is all one color with moulding on the entire wall.

Whew - that last photo is a “drop-dead” gorgeous one. I wish my powder room was that size…