Bring a large pot of water to a boil and cook the bow tie pasta according to the directions on the box, stopping when the noodles are tender, but still firm. Reserve one cup of cooking water for later. Drain the pasta, cover, and keep warm.
In a large skillet over medium-high heat, add two Tbsp. of olive oil in a large skillet over medium-high heat. Add sausage and sauté until sausage is cooked through and no longer pink, breaking it up as you go. Add onions and garlic and sauté until the onion is soft and sausage is completely browned- about four minutes. Add the tomatoes and cream (and dried basil if necessary). Reduce the heat to low and simmer until it becomes slightly thickened – about five minutes. Season the sauce with salt and pepper to taste.
Add the pasta to sausage-sauce mixture in the skillet and stir together until noodles are coated. Add a little reserved cooking water if mixture seems dry. Transfer the pasta to a large serving dish and sprinkle with basil on top. Serve immediately with grated Romano or Parmesan cheese separately.