Páramos, a neotropical alpine grassland-peatland biome of the northern Andes and Central America, play an essential role in regional and global cycles of water, carbon, and nutrients. They act as water towers, delivering water and ecosystem services from the high mountains down to the Pacific, Caribbean, and Amazon regions. Páramos are also widely recognized as a biodiversity and climate change hot spots, yet they are threatened by anthropogenic activities and environmental changes. Despite their importance for water security and carbon storage, and their vulnerability to human activities, only three decades ago, páramos were severely understudied. Increasing awareness of the need for hydrological evidence to guide sustainable management of páramos prompted action for generating data and for filling long-standing knowledge gaps. This has led to a remarkably successful increase in scientific knowledge, induced by a strong interaction between the scientific, policy, and (local) management communities. A combination of well-established and innovative approaches has been applied to data collection, processing, and analysis. In this review, we provide a short overview of the historical development of research and state of knowledge of the hydrometeorology, flux dynamics, anthropogenic impacts, and the influence of extreme events in páramos. We then present emerging technologies for hydrology and water resources research and management applied to páramos. We discuss how converging science and policy efforts have leveraged traditional and new observational techniques to generate an evidence base that can support the sustainable management of páramos. We conclude that this co-evolution of science and policy was able to successfully cover different spatial and temporal scales. Lastly, we outline future research directions to showcase how sustainable long-term data collection can foster the responsible conservation of páramos water towers.