Hydropower has been increasingly seen as a two-fold solution to the provision of renewable energy and water storage. However, the massive deployment of both large and small scale hydropower projects has been reported to cause important environmental impacts at the basin scale. This study assesses the differential contributions to regional energy and water security of large (LHP) and small (SHP) scale hydropower deployment in the Spanish Duero basin, as well as associated cumulative environmental impacts. This is performed through a selection of indicators measured in absolute and relative terms. The results suggest that LHP deployment contributes more to energy and water security, performing better in 10 of the 12 indicators. It also shows higher absolute environmental impacts on flow regime and habitat loss. Meanwhile, when analyzed in relative terms, SHP shows greater impacts in all categories as a result of cumulative effects cascading along the rivers system. These findings suggest that optimizing the use of existing hydropower infrastructure would be beneficial for energy, water and environmental security. This could be implemented by substantially reducing the number of low capacity plants with almost no impact on final energy generation, while enhancing the pumping and storage potential of higher capacity plants.