Polyvinyl alcohol (PVA)-based hydrogels have attracted significant attention due to their excellent biocompatibility, tunable mechanical properties, and ability to form stable three-dimensional networks. This comprehensive review explores the recent advancements in PVA-based hydrogels, focusing on their unique properties, fabrication strategies, and multifunctional applications. Firstly, it discusses various facile synthesis techniques, including freeze/thaw cycles, chemical cross-linking, and enhancement strategies, which have led to enhanced mechanical strength, elasticity, and responsiveness to external stimuli. These improvements have expanded the applicability of PVA-based hydrogels in critical areas such as biomedical, environmental treatment, flexible electronics, civil engineering, as well as other emerging applications. Additionally, the integration of smart functionalities, such as self-healing capabilities and multi-responsiveness, is also examined. Despite progress, challenges remain, including optimizing mechanical stability under varying conditions and addressing potential toxicity of chemical cross-linkers. The review concludes by outlining future perspectives, emphasizing the potential of PVA-based hydrogels in emerging fields like regenerative medicine, environmental sustainability, and advanced manufacturing. It underscores the importance of interdisciplinary collaboration in realizing the full potential of these versatile materials to address pressing societal challenges.