I have a SQL Server 2008 R2 server with several instances installed. Is there a way to add a new instance and have it be to the same build as the existing (and updated / patched) instances?

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No, unfortunately there is no magic "be like that guy" feature. What you have to do is either:

  1. install RTM and then apply the SP + CU; or
  2. slipstream the same SP + CU into the RTM binaries and install that. These instructions are applicable to both SQL Server 2008 and SQL Server 2008 R2, though the process is a little easier in SQL Server 2012.

The former is easier but could require more downtime.

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