A winter and spring of rehabilitation failed to cure the recurring knee problem and she had surgery in May. At the end of June in her first race in eight months, she won her fifth British title. The following month Cooke won the Giro d'Italia Femminile, the youngest winner and the first British cyclist, male or female, to win a Grand Tour. At the 2004 Summer Olympics she placed fifth in the women's road race and 19th in the road time trial.