Recycled aggregate concrete (RAC) has been widely investigated for recent decades, during which there are a great deal of findings on the modification of RAC to overcome the drawbacks of RA, i.e. high absorption and low strength. In this paper, four methods for designing and preparing RAC are reviewed, including the particle packing method (PPM), equivalent mortar volume (EMV) method, two-stage mixing approach (TSMA) and distributing-filling coarse aggregate (DFCA) process, and their effects on the properties of RAC is compared to reveal the effective approaches to high-performance preparation of RAC. Among these methods, only TSMA presents a positive effect on the workability of RAC. In terms of the properties of hardened RAC, TSMA improves the compressive strength and penetration resistance by densifying the ITZs around RA, and the developed TSMAsc containing silica fume exhibits better efficiency in improving the properties of RAC. The EMV method and DFCA process are beneficial to the compressive strength, elastic modulus and volumetric stability of RAC, and the effectiveness of the DFCA process is superior to the EMV method, indicating that enhancing the coarse aggregate interlocking effect is an effective approach to obtain high-performance RAC. Furthermore, the combination of TSMA and EMV methods can synthesize the enhancements of ITZs and coarse aggregate interlocking effect, contributing to a further improvement in the properties of hardened RAC. It is conceived that the TSMA and DFCA process can be integrated as a promising combination to realize the high performance of RAC.