This paper presents a review of the recent work assessing the performance of building structures strengthened with engineered cementitious composite (ECC). ECC characterizes tensile strain hardening and multiple cracking properties, as well as strong interfacial bonding performance with substrate concrete, which makes it a promising retrofitting material. A lot of researches have been conducted on reinforced concrete (RC) structures, including beams, columns, beam–column joints, and fire-damaged slabs, strengthened with ECC material, and an extensive collection of valuable conclusions were obtained. These strengthening systems usually combine ECC with FRP textiles or steel bars to form a composite strengthening layer. The review demonstrates that ECC strengthening can greatly improve the performance of RC structures.