In order to explore the toughening performance and failure mechanism of hollow slab beams strengthened with prestressed steel strand polyurethane cement composite, three test beams (L1–L3) were strengthened and one test beam (L0) was used as a comparison. The influence of different tensile stresses of steel strand and fiber additions on the flexural bearing capacity of the hollow slab beams, was studied. The cracking characteristics, load deflection relationship, ductility and strain of each test beam were compared and analyzed. The test results showed that the toughened material was well bonded to the hollow slab beam and the steel strand, which effectively inhibited the development of cracks in the test beams. The flexural bearing capacity of the strengthened test beams was significantly improved. The use of prestressed steel strand polyurethane cement composite material effectively improved the flexural bearing capacity of the test beams, and this reinforcement process can be further extended to engineering applications.