The Scream 4 killers are Charlie Walker and Jill Roberts, and the ending explains that Jill wanted the fame of being the sole survivor. Charlie is revealed first, after he stabs Kirby, and he stands beside a second Ghostface who turns out to be Jill. Her plan was to frame her ex boyfriend Trevor, kill him, then kill Charlie, and wound herself so she would look like a victim.
The hospital finale is where the film earns its place in the series. Dewey and Gale work out that Jill is guilty because she mentioned a detail of Gale's attack that was not public. Jill goes after Sidney in her room, Sidney shocks her with a defibrillator and then shoots her, and Jill dies. Outside, reporters wrongly call Jill a hero, which is the film's last joke about media fame. Sidney, Gale and Dewey all survive, and Kirby returns as an FBI agent in Scream VI.
In my opinion, the hospital scene is a better ending than the one the film started with, since the original script ended at the house with a cliffhanger and the hospital finale was added later. A cliffhanger would have left Jill's motive unanswered, while the hospital gives the plan a proper consequence: the girl who staged her own wounds is the one the cameras get wrong. Perhaps the bigger point is that Jill wants an audience, and that is a different kind of killer from the earlier films.
It could be argued that the series has been building to this since its second entry. Scream 2 opens with a Stab screening, so the in-universe movie was already feeding the murders, and Scream 3 moves to the set of Stab 3 in Hollywood. Scream 4 takes the next step by making the killer's goal the coverage itself. Charlie's remake rules speech works as a warning for the audience, because the film then follows those rules, with a Stab marathon party as the set piece where Gale is stabbed.
There is also a contrast with the other pairs of killers in the saga. Here the partnership is lopsided, since Jill is planning to kill Charlie from the start, and the reveal turns on a detail only the attacker could know rather than on a mask coming off. The same idea of a young Woodsboro survivor carrying the story appears again when Scream (2022) opens with Tara Carpenter, so Jill reads, in hindsight, as a dark preview of the new generation. The full list of culprits sits on the Ghostface killers page, and the series' habits are laid out in the Scream rules.