The central twist reveals that the "missing painting" Marcus thought he saw was never a painting at all. It was a mirror reflecting the face of the killer, Martha (Carlo's mother), who was hiding in the hallway when Marcus entered. This means Marcus looked directly at the killer but his mind processed it as art to cope with the shock.
Martha is revealed to be a murderous matriarch who killed her husband years ago (the scene in the prologue) to prevent him from institutionalizing her. Carlo witnessed this as a child, traumatizing him. He was not the killer, but he helped cover for his mother. In the end, Martha is killed when her necklace gets caught in the elevator bars, decapitating her—a gruesome poetic justice linking back to the theme of being bound by the past.