To set up Spine with MonoGame, you need to ensure that you have the correct version of MonoGame that is compatible with your development environment. The example project for Spine with MonoGame might be outdated, as it was originally created for Visual Studio 2015 and MonoGame 3.0, which are not supported by newer versions of Visual Studio like 2019. You will need to update the project to use a newer version of MonoGame, which can be installed via NuGet or downloaded separately. Additionally, you should copy the spine-csharp source files into your project, as they are necessary for integrating Spine with MonoGame.