Bernie, most of our tools are nearly 10 years old or are free. We purchase WebNM, HP OpenView, and a couple of Wireless tools. The rest are relics in this day and age, but they work.

A few of the items that we established early on:
1) We do all IP address assignments. This got us off of spreasheets really early. We use Nortel's ADM (Formerly NetID) for this, and have been using this for eight years.
2) All ports are deactivated upon install. All activations are on Tuesdays and Thursdays, and require documentation including MAC addresses.
3) Showing the problems to Managment using graphs they can understand, showing the $$ required to upgrade vs. the cost of cleanup (invariably less to cleanup when it is the same problem on thousands of desktops - ZEN works!), and having Managment realize they have the power to implement change works quite well.
4) Our Enterprise IP scheme was planned out almost 10 years go. This is still a valid template, with the only modification is the addition of some VLSM segments. There is room for expansion in our design, as well as OSPF area and route summary capability.

Personally, I used to be the IS manager of a Law firm. If you thought a non-profit Hospital would be stingy, work for a Doctor's Practice Group or a Law office! Yet, once I showed how desktop image cleanup improved efficiency, reduced calls, and reduced complaints about the 'Network is slow!', I was able to get the funding I needed for other upgrades and projects.