The ability of mesenchymal stromal cells (MSCs) to migrate into tissue defects and stimulate regeneration makes them a valuable resource for cell therapy. However, in many cases, in vitro cultivation and the influence of the pathological microenvironment in the patient’s body reduce the viability and therapeutic efficacy of MSCs, so their regenerative potential needs to be strengthened. Preconditioning with hormones, cytokines, various chemical or physical factors, cultivation in a three-dimensional environment or at a reduced oxygen content improves the ability of MSCs to colonize damaged tissue, survive in it, and produce regulatory molecules for regeneration. The same goals can be achieved by genetic modification of MSCs. In addition, with the help of transfected MSCs, it is possible to deliver genes necessary for the treatment of hereditary or oncological diseases into the tissue. Finally, an alternative to avoid a decrease in the therapeutic potential of subsequently transplanted MSCs during cultivation can be stimulation of the migration of endogenous patient cells from tissue niches through the systemic circulation to the area of damage. The development of these approaches opens the way to increasing the efficiency of using MSCs in regenerative medicine.