Sewage sludge to energy conversion is a sustainable waste management technique and a means of militating against the environmental concerns associated with its disposal. Amongst the various conversion technologies, anaerobic digestion and gasification have been identified as the two most promising. Therefore, this study is focused on a detailed evaluation of the anaerobic digestion and gasification of sewage sludge for energy production. Moreover, the key challenges hindering both technologies are discussed, as well as the practical measures for addressing them. The applicable pretreatment measures for efficient transformation into valuable energy vectors were further evaluated. Specifically, the study evaluated various properties of sewage sludge in relation to gasification and anaerobic digestion. The findings showed that a high ash content in sewage sludge results in sintering and agglomeration, while a high moisture content promotes tar formation, which has been identified as one of the key limitations of sewage sludge gasification. More importantly, the application of pretreatment has been shown to have some beneficial features in promoting organic matter decomposition/degradation, thereby enhancing biogas as well as syngas production. However, this has additional energy requirements and operational costs, particularly for thermal and mechanical methods.