In recent decades, masonry constructions have garnered significant attention from researchers, driven by both theoretical challenges and practical needs. This interest stems from the complex behaviour of masonry as a material and the difficulties inherent in accurately modelling real-world structures. Moreover, masonry constructions comprise a substantial portion of the global architectural heritage, including historic buildings, monuments, and arch bridges. Originating with the Romans, masonry arch bridges proliferated across Europe until the nineteenth century, forming a critical part of transportation infrastructure. Today, thousands of such structures remain in service but are experiencing progressive deterioration due to prolonged exposure to adverse environmental conditions and extreme events. As a result, developing reliable strategies for their assessment, preservation, and structural enhancement has become essential. To achieve this, modern approaches that extend beyond conventional design codes are required, emphasizing a deep understanding of masonry behaviour. Restoration efforts should prioritize minimal intervention to maintain historical authenticity. This paper explores the most common structural issues affecting historical masonry arch bridges, reviews restoration strategies, and presents selected case studies demonstrating their application.