Hygienization reduces the public health risks involved in the application of biowaste to agricultural land. Recent advances in the hygienization of treated biowaste have not been reviewed to date. In many countries, the process involves using low temperature thermal pasteurization. Thermal hygienization accounts for between 6% and 25% of primary energy production in European biogas plants. Hygienization pretreatment can also influence the production of biogas by the treated substrates (from a slight negative effect to a biogas yield surplus of 50% in most cases). Alternative athermal pasteurization technologies (including electro-technology, microwave, pressurization, ultrasound and chemical treatment) have been shown to be capable of considerably reducing the number of bacteria and increasing the methane yield. The performance of these alternatives varies greatly and depends on the type of biowaste, the operational parameters studied, energy input and the method of interpreting the experimental results. Analyses of energy and exergy efficiency, of environmental impacts and of economic feasibility show that thermal hygienization may be the most energy efficient and economical approach when it exploits the wasted heat recovered from other processes. The present study also revealed that the research focus has been confined to the sewage sludge. Studies on the other biowaste, including animal by-products, are needed.