In this chapter, some innovative case studies in the hydropower sector are discussed, highlighting how novel technologies and operational practices can make it more efficient, sustainable and cost-effective. Some practices to reduce hydropeaking effects, improving fish habitat, and turbines with higher survival rate, allowing to bring fish survival >98%, are discussed. The retrofitting of non-powered barriers can help to minimize the environmental impacts, reducing costs by more than 20%. New turbines are described focusing on their advantages with respect to standard ones, in particular, water wheels in irrigation canals to promote the valorization of watermills and old weirs, the very low head (VLH) turbine in navigation locks (reducing overall cost by more than 20%), the vortex turbine, and the Deriaz turbine with adjustable runner blades to improve the efficiency curve, especially at part load. Digitalization can help in preventing damages and failures increasing the overall efficiency and energy generation by more than 1%.