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The high‐mountain system, a storehouse of major waterways that support important ecosystem services to about 1.5 billion people in the Himalaya, is facing unprecedented challenges due to climate change during the 21st century. Intensified floods, accelerating glacial retreat, rapid permafrost degradation, and prolonged droughts are altering the natural hydrological balances and generating unpredictable spatial and temporal distributions of water availability. Anthropogenic activities are adding further pressure onto Himalayan waterways. The fundamental question of waterway management in this region is therefore how this hydro‐meteorological transformation, caused by climate change and anthropogenic perturbations, can be tackled to find avenues for sustainability. This requires a framework that can diagnose threats at a range of spatial and temporal scales and provide recommendations for strong adaptive measures for sustainable future waterways. This focus paper assesses the current literature base to bring together our understanding of how recent climatic changes have threatened waterways in the Asian Himalayas, how society has been responding to rapidly changing waterway conditions, and what adaptive options are available for the region. The study finds that Himalayan waterways are crucial in protecting nature and society. The implementation of integrated waterways management measures, the rapid advancement of waterway infrastructure technologies, and the improved governance of waterways are more critical than ever. This article is categorized under:Engineering Water > Sustainable Engineering of Water [ABSTRACT FROM AUTHOR]