Burns initially pursued a career in general surgery, and for five years he was a consultant surgeon at the Glasgow Royal Infirmary. He took up a managerial role as the medical director of the Glasgow Royal Infirmary. He completed a master's degree in Public Health in 1990. He worked as deputy director of planning and contracts at Greater Glasgow in 1992, becoming the director of public health for Greater Glasgow the following year. In 1999 he was awarded a visiting professorship in public health medicine at the University of Glasgow, and he also became a senior research fellow in the School of Business and Management at the university.
