Large-scale hydro-steel structures (LS-HSSs) are vital to hydraulic engineering, supporting critical functions such as water resource management, flood control, power generation, and navigation. However, due to prolonged exposure to severe environmental conditions and complex operational loads, these structures progressively degrade, posing increased risks over time. The absence of effective structural health monitoring (SHM) systems exacerbates these risks, as undetected damage and wear can compromise safety. This paper presents an advanced SHM framework designed to enhance the real-time monitoring and safety evaluation of LS-HSSs. The framework integrates the finite element method (FEM), multi-sensor data fusion, and Internet of Things (IoT) technologies into a closed-loop system for real-time perception, analysis, decision-making, and optimization. The system was deployed and validated at the Luhun Reservoir spillway, where it demonstrated stable and reliable performance for real-time anomaly detection and decision-making. Monitoring results over time were consistent, with stress values remaining below allowable thresholds and meeting safety standards. Specifically, stress monitoring during radial gate operations (with a current water level of 1.4 m) indicated that the dynamic stress values induced by flow vibrations at various points increased by approximately 2 MPa, with no significant impact loads. Moreover, the vibration amplitude during gate operation was below 0.03 mm, confirming the absence of critical structural damage and deformation. These results underscore the SHM system’s capacity to enhance operational safety and maintenance efficiency, highlighting its potential for broader application across water conservancy infrastructure.