Biomass bottom ash (BBA) is a by-product of the energy industry and is produced from biomass-fired thermal power plants. They represent the coarsest fraction of the recovered ash and are mostly landfilled. Several researchers have investigated the feasibility of the use of BBA as a replacement for natural aggregates in cementitious material. The utilisation of BBA in the manufacturing of concrete provides an economic and ecological way to upcycle it. At the same time, its use conserves natural resources and promotes sustainability. This review article first presents the chemical, mineralogical and physical properties of BBA, to highlight the possible effects on cementitious materials and the interest in valorising them as a building material. Secondly, the focus is on the utilisation of BBA incorporated in place of natural aggregates used in the manufacturing of concrete. This review investigates the multi-physical properties of concrete manufactured with the partial incorporation of BBA. This substitution leads to decreased workability, which can be limited by the use of admixtures. In the hardened state, a reduction in the mechanical properties is shown with BBA replacement. However, many experimental works show that BBA can be used in appropriate proportions to maintain the specified properties of the concrete.