Stroke is the leading cause of long-term disability costing the United States (US) health care system 34 billion dollars. However, stem cell based therapies have been shown to improve recovery after cortical injury by enhancing neural recovery and modulating immune responses (Lambertsen, Finsen, & Clausen, 2018; Orczykowski et al., 2018; Stonesifer et al., 2017). Specifically, reorganization of the motor circuit at the level of the spinal cord has been shown to improve functional recovery after injury (Christoph Wiessner; Weidner et al., 2001; Lee et al., 2004; Zai et al., 2009). In our study we used a non-human primate (NHP) model to study the neural recovery after cortical injury similar to damage from an ischemic stroke in the motor cortex with or without a systemic treatment of mesenchymal stem cell derived (MSCd) exosomes. We find a robust recovery in motor function within the first few weeks after injury including improved grasp patterns and faster retrieval times during behavioral tasks. Additionally, assessment of the cervical spinal cord (CSC) reveals decreased levels of sprouting axons from ipsilesional corticospinal tract (CST) and MAP2+ synapses in the contralesional ventral horn at 14 weeks post-injury, which correlates with improved retrieval latencies. We hypothesize that MSCd exosomes may encourage an earlier switch to anti-inflammatory and repair processes that reduces secondary damage in the cortex resulting in earlier pruning of axon collaterals and reducing the need for compensatory mechanisms of the spinal cord at 14 weeks post injury.