Fran Bow is a horror-themed point-and-click adventure game. Set in 1944, the game tells the story of Fran Bow Dagenhart, a young girl experiencing strange and tragic events. One night, she wakes up to find her parents butchered and runs out into the woods in shock. She is caught and sent to a mental hospital, where she is forced to take experimental drugs which cause strange hallucinations, including seeing a demon with a goat mask. Her only goal is to escape the hospital in hopes of finding her cat, Mr. Midnight, and returning home to her Aunt Grace. The game is broken up into five chapters, with each one taking place in an increasingly surreal environment.

The gameplay consists of speaking to characters, exploring the environment, and solving inventory and standalone puzzles. Depending on the chapter, the player is able to switch between several different versions of a location in order to find more clues and items. Occasional action sequences also occur, usually at the end of each chapter. These include walking through a maze and a Frogger-style game.