The Central Asian area is confronted with a number of acute obstacles as it attempts to transition to a long-term electrical power supply. Small-scale hydropower systems may be a viable answer to these problems. Central Asian nations' hydropower resources are allocated unevenly. Regardless, it remains the most exploitable renewable energy source in the area, with both Kyrgyzstan and Tajikistan possessing some of the world's highest hydropower potential. Nonetheless, for fossil-fuel-rich nations like Uzbekistan, Turkmenistan, and Kazakhstan, hydropower will play a significant role in the future energy balance. Furthermore, because rivers often run across many boundaries, water security plays an important role in cross-border relations between Central Asian countries. To achieve effective exploitation of small hydropower potential, technological and financial expenditures are needed to improve the levelised cost of energy (LCOE) of diverse hydroelectric equipment by increasing lifetime, improving efficiency, and increasing yearly power output. Several of these issues can be resolved by installing small and micro hydropower plants in the many minor rivers and irrigation canals. A pumped hydro energy storage system should also be tested and certified for better usability. A hydrological digital twin of relevant river system and irrigation network should be constructed to increase the understanding for performance and enable system-level improvement. Furthermore, optimal performance necessitates constant monitoring of the network, necessitating the development of intelligent monitoring employing sensors in conjunction with control systems and smart grid interactions. This review focuses on the broad and efficient use of these existing resources, which are still underutilized.