They have VMs and sell them as "cloud" but provisioning happens like you fill out a form and they give you a server. It's not instant but fast enough if you don't spin VMs up and down like crazy.
The thing to remember with Hetzner is that they are cheap. Low prices and good infrastructure but you have to do quite a bit yourself and many features one expects from a cloud provider aren't available. Last time I checked they don't have an API to change DNS settings for your domains. You can write GPG signed emails to a bot but I don't know how well that works.