This experiment compared the effects of sand and straw bedding in free stalls on resting time, cleanliness, hock injuries, and hoof health of dairy cows and tested whether cow preferences for a bedding material depended on the familiarity with the material. A total of 52 dairy cows were kept either on straw bedded concrete stalls or sand stalls for at least 21 wk. The lying behavior was observed, and hock lesions, hoof health, and cleanliness of the cows and stalls were measured. A 5-d preference test between sand and straw stalls was conducted at the end of the experiment. The total daily duration of lying was longer for cows on straw bedding than on sand bedding (straw 749 +/- 16 vs. sand 678 +/- 19 min). During the preference test, cows that had been kept on straw bedding preferred lying in straw stalls [straw 218.7 (133.4 to 239.7) vs. sand 9.0 min (2.8 to 44.8)]; however, cows that had been kept on sand showed no preference [straw 101.3 (51.7 to 205.9) vs. sand 94.3 min (54.1 to 156.1, median and interquartile range)]. Although there were no differences in the dirtiness of stalls, the cows using straw stalls were dirtier than cows using sand stalls [straw 6.04 (5.39 to 6.28) vs. sand 4.19 (3.62 to 5.16)]. At the end of experiment the severity of hock lesions was lower for cows on sand than for cows on straw [sand 0.5 (0.0 to 1.0) vs. straw 1.0 (1.0 to 2.0)]. The improvement in overall hoof health over the observation period was greater for cows kept on sand compared with cows kept on straw [sand -2.00 (-3.75 to -0.25) vs. straw 0.00 (-2.00 to 2.00)]. Straw bedding increased the time that cows spend lying, and cows preferred straw stalls to sand stalls. However, previous experience with sand reduces avoidance of sand stalls. Sand stalls were advantageous for cow cleanliness and health; hock lesions and claw diseases healed more quickly for cows using sand stalls compared with straw.