You can get efficiencies of above 80%. In larger installations 90% or more. It's expensive but beats the shite out of solar and wind over time. You can also, if you have an application for physical energy, roughly double the output.
In addition almost all energy storage capacity for the grid is pumped storage from hydroelectric stations. I think it is massively overlooked merely because most people are interesting in scaling and these people overlook the fact that A: most things do not scale and B: long term maintenance matters. You can run a hydro plant with next to no maintenance for 100 years. I can't think of anything close to it and they can easily be fixed or repaired.
It annoys me that micro and small hydro aren't talked about more.