The server component is used to send studies from the imaging devices to a computer for long term storage so we don't keep them on the imaging devices themselves. We keep it running all the time mainly for simplicity (techs don't need to deal with a computer at all). The KPautostart thing I mentioned was something I saw in the instructions on the download page, but its probably out of date by now.
"3. To start K-PACS Server on Windows startup, link the file KPautostart.exe in [your K-PACS directory)\K-Pacs-Server] to the autostart directory of the “Start” menu."
I will look into ConQuest, thanks for the suggestion. You are probably right in that there is more appropriate software for the desired job.
In the meantime, I will also look to see if the service idea works too. I'm not sure if adding KPServer.exe to startup will work, because when I run that exe manually, the server doesn't actually stay running, just runs for a split second and turns off. It only stayed running after running K-Pacs itself.
As for it not working on Windows Server directly, I guess I can simply run it from inside a virtual machine as a last resort if I needed to. That computer is basically the only computer guaranteed to stay on, be on, always running etc, hence my desire to run the KPServer process on it over a normal workstation.