Whatever you do, you are going to change what it currently looks like. I agree with cjsews that it looks like it is cut from a longer piece and because of the ties probably a seat cover. It looks quite warped. You could make it into a wall hanging by adding a whole new border and binding. I'd be tempted to use a rotary cutter and slice off the prairie points using the quilt edge to work from. But only after I had a solid plan of what to do next. I would be afraid that picking them out could harm the lovely hand-quilted hearts. Alternately, you could make it look like a "book" by finishing the cut edge to look like a book binding rather than trying to match. You could square it up with a border sewn under the prairie points - you'd have to top-stitch it in the ditch around the three edges.
Does your friend have some idea of what they would like it to be or look like?