During the long-term operation of main run-of-river head powerhouses for hydroelectric power plants, technical changes that deteriorate the operational properties of their reinforced concrete structures can occur. Therefore, in order to substantiate the application of prestressed basalt composite reinforcements to strengthen reinforced concrete hydraulic structures in operation, a set of computational and experimental studies was carried out, taking into account their characteristic features. After 4 years of ageing, the serviceability and reliability of the beams with prestressed basalt composite reinforcements were demonstrated through stabilisation of the prestress losses and the values obtained for bearing capacity, deflection, and the width of the opening of the inter-bay construction joints and the deformations of the metal reinforcements and the basalt composite reinforcements. The bearing capacity of the investigated reinforced concrete beams reinforced with external transverse reinforcements was increased 1.4–2.5 times over that of the variants reinforced with longitudinal prestressed basal composite reinforcements. Furthermore, in this study, the impacts of static loads and seismic effects with a magnitude greater than 8 on the run-of-river hydroelectric power plant powerhouse were calculated based on dynamic design theory. Regarding applications to hydroelectric power plant structures and constructions, for which it is not always possible to determine the location of compressed or tensile zones during their operation nor under seismic action, our research results are suggestive of a reasonably positive effect.