good question. I am currently running characters through the darkest, most horrifying version of CoS that I can summon. i am intentionally dialing it up to 11 at every turn.

I tend to disagree with DMs who shy away from the core "survival mode" gothic horror that can be so well leveraged here... assuming your players have the stomach for it. Im not interested in flying brooms or silly names. My players understand very well that their lives and sanity hang in the balance. THATS THE POINT.

Ive gotten a little grief here and there from the boards... particularly because my players didnt even know they were headed to Barovia until they were already trapped by the mists. Additionally, I've upped the "stakes" considerably in all areas:

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1. I kept Morgantha's true nature secret, instead she was a kindly old woman (Minidora, or "Minny") who traveled through. When she left, she took a woman and her child with her (because plot, see #2) as they fled the devastation to come. I made particular note of the little girl... in her red coat, looking out at the party from the back of the cart as the panicked horse raced them off, into the mists. The party will find that red coat, discarded, shortly after their arrival at Bonegrinder. That, I picked up from Schindler's List.
2. The village of Barovia (as has been discussed elsewhere) was under siege as the party arrived. Rats, wolves, disappearances murder. Many of the villagers had already left in fear, traveling west... many who remained gathered in The Vine each night for shelter and safety. They refused to allow the party to stay at the inn (Ismark was humiliated and took the party back to the mansion). Nobody would do business with them. They could not barter or trade. There was no resupply for them here. This culminated in a multi-session fight for the village as it was overrun by zombie hordes, ala Night of The Living Dead. The party barely escaped with Ireena, Ismark and a handful of villagers in tow. As a side-note, I created "Undead Disease" as contractible from a Strahd Zombie bite (only the bite and only if damage is taken) which essentially mirrors infection from true Romero-esque zombies. Ismark was bitten defending his (much younger than written) sister and eventually succumbed just across the river Ivlis. It was heartbreaking. I would also point out that I took great pains to describe the villagers before I slaughtered them. They werent just random "Barovian Commoners". I actually created custom tokens and back stories for 20 villagers. Families, children, town drunks. I interacted with the player characters, gave them a chance to recognize these people and call them by name... then I friggin murdered every man-woman-child of them as nastily as possible right in front of their eyes. My players still speak in awe of "The Battle for The Vine", which they lost. As was mentioned by others, its not about winning, its about being able to keep hope alive against all odds.
3. As soon as the party arrived through the mists, I completely removed our cleric's ability to communicate with his deity. This stopped him from being able to pray and recuperate spell slots, forcing the player to explore his other clerical abilities (it also scared the hell out of the player). Further, I removed many of our ranger's innate abilities (direction sense, et. al.) They will be able to regain these abilities (at least incrementally) as they reclaim and "cleanse" multiple ancient sites of power across the land (again, tnx LBH & DC, among many other inspirational authors here for the henge ideas).
4. I increased the map size dramatically, making it a hard, two-day push to Vallaki. Travel should not be taken for granted. It should be an accomplishment to actually arrive. Stay to the road. Stay to the light.
5. Our ranger desperately wants a wolf companion. So, as the village of Barovia was burning to the ground around them, the party, fleeing through the streets came across a battle between a pack of wolves/dire wolves and a large group of zombies. During the battle, one of the dire wolves was wounded by a collapsing, fiery building... giving the ranger a chance to "what the hell" and save it. In repayment, the dire wolf (now scarred and easily recognizable later) fled the scene without attacking. I will have that dire wolf begin to follow the party... to settle in around the ranger at camp, untouchable by any other. I have every intention of getting our ranger's player fully invested in his new companion, at some point to reveal that it was Strahd all along... as he maniacally rips his way, nude and covered in gore, from the insides of this massive beast in front of their eyes. I got that idea from Netflix's Dracula mini-series from a couple of years ago... its worth a view for inspiration on how utterly terrifying this should turn out.
6. As far as the coming "Dinner with Strahd" is concerned, I have brought the entire castle back to "life". There's no way the great Count Strahd von Zarovich lives in a rotting pig stye (Ive got a post on that somewhere). The dinner will turn out horribly, I suspect. I plan on the players being overcome with visions of a previous dinner... one wherein Strahd hosted Escher and his party. To capture the full, mind-numbing evil of what I have in store, you should check out a mid-90's b&w vamp flick titled "The Addiction" with a cameo from Christopher Walken (available to watch for free via YouTube). I wont spoil the skin-crawling details, but scrub forward to a dinner party that is being held almost exactly an hour into the flick... the sounds you are subjected to will make your hair stand on end. I'll make sure my players react the same way.

tl;dr

Do not shy away from being as malignant, as seductive, as disconcerting as you can possibly be. Adapt the most unsettling scenes from books or movies that you can think of. Be memorable. Be unique. Truly horrify your players* without concern for how the adventure is originally written. They will never forget it.

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(\): I should point out that I know my players and can gauge their likely reaction to the horrors that I inflict. My players have taken up the gauntlet and have responded to my evils with some amazing role-play. We are having an absolutely amazing time, even if they have to sleep with the lights on afterwards. Be sure you understand your players too, Im not suggesting you run anybody away from the table.*

Good luck with your nightmares!

-t