Although public and financial support for stream restoration projects is increasing, long-term monitoring and reporting of project successes and failures are limited. We present the initial results of a long-term monitoring program for the Lower Red River Meadow Restoration Project in north-central Idaho, U.S.A. We evaluate a natural channel design’s effectiveness in shifting a degraded stream ecosystem onto a path of ecological recovery. Field monitoring and hydrodynamic modeling are used to quantify post-restoration changes in 17 physical and biological performance indicators. Statistical and ecological significance are evaluated within a framework of clear objectives, expected responses (ecological hypotheses), and performance criteria (reference conditions) to assess post-restoration changes away from pre-restoration conditions. Compared to pre-restoration conditions, we observed ecosystem improvements in channel sinuosity, slope, depth, and water surface elevation; quantity, quality, and diversity of in-stream habitat and spawning substrate; and bird population numbers and diversity. Modeling documented the potential for enhanced river–floodplain connectivity. Failure to detect either statistically or ecologically significant change in groundwater depth, stream temperature, native riparian cover, and salmonid density is due to a combination of small sample sizes, high interannual variability, external influences, and the early stages of recovery. Unexpected decreases in native riparian cover led to implementation of adaptive management strategies. Challenges included those common to most project-level monitoring—isolating restoration effects in complex ecosystems, securing long-term funding, and implementing scientifically rigorous experimental designs. Continued monitoring and adaptive management that support the establishment of mature and dense riparian shrub communities are crucial to overall success of the project.