This review provides an overview of the engineering and application of extracellular matrix (ECM) hydrogels. ECM hydrogels are attractive materials for tissue engineering and regenerative medicine due to their unique ability to mimic the natural ECM of various tissues. The review discusses the different methods used for the preparation of ECM hydrogels and the factors that influence their properties. This review is the summary of three engineering approaches for ECM hydrogels, which are chemical modification of the gel scaffold (chemical modification), addition of active substances to the scaffold (physical addition), and gene editing of the ECM donor (biological modification). Additionally, it covers the various applications of ECM hydrogels in tissue restoration, organoid culturing, and 3D microenvironment reconstruction. The review concludes with a discussion of the advantages, limitations, and future directions of ECM hydrogel research and development. Overall, this review highlights the potential of ECM hydrogels as a promising biomaterial for a range of biomedical applications and provides fresh perspectives for ECM hydrogels to continue their clinical development.