Fans fans fans. If you don't replace the fans, run it with a couple of 80mm fans mounting alongside it just in case.

Capacitors should be replaced, if not already done. this era was known for them failing. Improper voltages can cause irreparable damage.

Might be worth while to remove the fans and give them a good cleaning and then add a few drops of fresh oil to there bearings.

Thanks for the tips, I've already ordered a replacement cooling solution (I'll post about that when I get it) and am ordering high quality replacement caps this weekend.

I freeze sprayed the stock wimpy heatsinks off, now I gotta try and get rid of the remaining old gunk, but it's pretty tough. Not sure how comfortable I am about using anything stronger than IPA, so maybe I just need to use some elbow grease.

Here is the cooling solution I used for the VSA chips. Not cheap, and perhaps overkill, but it's what I wanted.

Heatsinks are Enzotech Northbridge coolers, and they fit the mounting holes on the V5 PCB without modification

For fans, I used these Noctua 5V 40mm fans. I was only able to screw down to the heatsink on a single corner, due to the slight size mismatch, but they stay put just fine.
It was necessary to change the connector on the end of the fan cable, as the Noctua connector was bigger than the connector the V5 uses.

And also some generic ram heat sinks

And here is the card now

Coolers attached and recapped with good caps.
It was good that we did that, because although it looked ok to the eye, after removing old caps there was signs of leakage, and a little damage in one spot, which we got nicely cleaned up.
Card is working great, and thanks to your advice, will hopefully continue to work well for some time.

It looks great, should be nice and cool now.
As long as it's handy, it's also a good idea to touch up the solder on the pins of the power connector, just in case those joints are getting weak.

The only thing that worries me is the plastic push pins. They can break or pop loose sometimes and I had a Ti4200 burn up because of that.
But if you only install them once and never reuse them, then the risk is a lot lower. Definitely don't think of them as reusable, at least not for this card.

I'd be in favor of checking a local hardware store for some suitable screws/washers/nuts though.
If you find something the right length with a smooth shaft you might even be able to keep the springs - but if it's a typical screw that's fully threaded then there's the risk that a spring gets hung up on the threads and stops applying pressure to the heatsink.