The block design test (BDT) has been used for over a century in research and clinical contexts as a measure of spatial cognition, both as a singular ability and as part of more comprehensive intelligence assessment. Traditionally, the BDT has been scored using methods that do not reflect the full potential of individual differences that could be measured by the test. Recent advancements in technology, including eye-tracking, embedded sensor systems, and artificial intelligence, have provided new opportunities to measure and analyze data from the BDT. In this methodological review, we outline the information that BDT can assess, review several recent advancements in measurement and analytic methods, discuss potential future uses of these methods, and advocate for further research using these methods.