The man, a Romanian national, had remained conscious during the long rescue operation before being hospitalised in critical condition on Monday night, according to authorities.
"Resuscitation attempts were made for about an hour to save Octay Stroici," Italian news agency ANSA said, citing the Umberto I hospital.
"Despite this, spontaneous cardiac activity could not be restored" and his "death was pronounced at 12:20 am."
He had been helping to renovate the Torre dei Conti, which partially collapsed shortly before midday on Monday, sending rubble into the street and a thick white cloud of dust into the air.
READ ALSO: One trapped after tower collapse at Rome's Imperial Forums
Three other workers were earlier evacuated from the site, one of them in critical condition, a spokesman for the fire service told AFP.
The tower is in a busy area, just off the Imperial Forum and close to the Colosseum, Italy's top tourist site.
A second partial collapse of the tower about one and a half hours after the first incident sent up further billowing clouds of dust.
WATCH: Rome medieval tower collapses for second time during rescue
After the first collapse, firefighters managed to "put up some protection" around the trapped man, so when the second collapse occurred he was shielded, Rome Prefect Lamberto Giannini said.
One worker inside at the time of the first collapse told AFP he escaped from a balcony.
"It was not safe. I just want to go home," said the man, white dust covering his uniform, who gave his name as Ottaviano and his age as 67.
The Torre dei Conti, dating from the early 13th century, was being restored with European Union funds.
Monday's collapses affected a buttress and part of the tower's base, then part of the stairwell and the roof, Rome's Directorate of Cultural Heritage said in a statement.
The phase of work launched in June 2025, which included asbestos removal, was practically complete.
The directorate said an analysis undertaken on the start of the renovations had shown the "necessary safety conditions" for the work to go ahead.
The Italian government on Monday night summoned Russia's ambassador after the Russian foreign ministry spokeswoman made a link between the accident and Italy's support for Ukraine.
"As long as the Italian government keeps uselessly wasting taxpayers' money, all of Italy will collapse, from the economy to its towers," said the spokeswoman, Maria Zakharova, on Telegram.
Italy's foreign minister, Antonio Tajani, slammed Zakharova's remarks as "shameful, unacceptable".
By AFP's Juliette Rabat.
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