Most cognate research suggests facilitation effects in picture naming, but how these effects manifest in bilinguals after brain damage remains unclear. Additionally, whether this effect is captured in clinical measures is largely unknown. Using data from the Boston Naming Test, we examined the naming of cognates and noncognates, the extent of cognate facilitation produced, and the individual differences in bilingual language experience associated with naming outcomes in forty Spanish–English bilingual persons with aphasia (BPWA) relative to thirty-one Spanish–English healthy bilinguals (HB). Results suggest that naming performance in L1 and L2 in both groups is modulated by lexical frequency, bilingual language experience, and by language impairment in BPWA. Although the two groups showed similarities, they deviated in benefit drawn from the extent of phoneme/grapheme overlap in cognate items. HB showed an association between cognate facilitation and bilingual language experience, while cognate facilitation in BPWA was only associated with L2 language impairment.