Mountains are essential sources of freshwater for our world, but their role in global water resources could well be significantly altered by climate change. How well do we understand these potential changes today, and what are implications for water resources management, climate change adaptation, and evolving water policy? To answer above questions, we have examined 11 case study regions with the goal of providing a global overview, identifying research gaps and formulating recommendations for research, management and policy. After setting the scene regarding water stress, water management capacity and scientific capacity in our case study regions, we examine the state of knowledge in water resources from a highland-lowland viewpoint, focusing on mountain areas on the one hand and the adjacent lowland areas on the other hand. Based on this review, research priorities are identified, including precipitation, snow water equivalent, soil parameters, evapotranspiration and sublimation, groundwater as well as enhanced warming and feedback mechanisms. In addition, the importance of environmental monitoring at high altitudes is highlighted. We then make recommendations how advancements in the management of mountain water resources under climate change could be achieved in the fields of research, water resources management and policy as well as through better interaction between these fields. We conclude that effective management of mountain water resources urgently requires more detailed regional studies and more reliable scenario projections, and that research on mountain water resources must become more integrative by linking relevant disciplines. In addition, the knowledge exchange between managers and researchers must be improved and oriented towards long-term continuous interaction. © Author(s) 2011.