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In 2019, after the release of the [[Hell Ghosts]] upon the world, Rowena chose to sacrifice herself to save the world by using her own body to cast all of the souls and demons back into Hell. At Rowena's request, and with great reluctance, Sam was indeed the one who fatally stabbed Rowena. Following Rowena's death, Sam inherited [[Rowena's Spellbooks|her magical stash]], as it's suggested that she intended.
When the Winchesters and Castiel
returned to Hell in search of [[Michael]], they discovered that Rowena's [[soul]] took up the empty position of Queen of Hell. Retaining her old personality, Rowena aided the Winchesters once again and even urged Dean and Castiel to mend their broken relationship.