Nancy Cook Smith was born profoundly deaf and attended the Clarke School for the Deaf in Northampton, Massachusetts, and later Glastonbury High School. Following high school, Cook Smith continued to pursue her longstanding interest in arts and crafts at the Rhode Island School of Design, where she graduated in 1974 with a Bachelor of Fine Arts degree in textiles.

Cook Smith then started her career as a designer with India Imports of Providence, Rhode Island. She subsequently set out as a designer on a freelance basis and moved to Los Angeles.