The river continues from the dam to Gouverneur, to near Talcville in St. Lawrence County, where it joins the West Branch.

The Middle Branch Oswegatchie River mostly consists of shallow and fast-moving waters with only two or three slow-moving sections favorable for canoeists.

Occasionally, experienced kayakers take advantage of high water conditions to ply its waters – generally from the Bear Pond Road, a few miles upstream of Alder Bed Flow, and downstream to another seasonal access road located near Mullins Flow.

The Branch's far-upstream sections consist of small and narrow feeder streams, which are generally not favorable to canoeists due to fallen logs and overhanging alders.

During the Great Depression, New York State purchased deeded fishing rights for the public on most of the river.

[citation needed] Today, no sign of the trail has survived, but the deeded fishing rights for the public remain, despite new landowners in some locations.

The lower part of the main stem of the river, between Gouverneur and Ogdensburg, is slow-moving, with some rapids that can be handled by experienced canoeists.

Important fish species include smallmouth bass, northern pike, musky, channel catfish, walleyes, red-finned mullet, and common carp.

There is a 3.5-mile (5.6 km) portage at the old historic "Beaverdam" by which canoeists can hike to continue their paddling at Lows Lake and the Bog River.