Climate change will likely generate additional risks to the sustainable operation of water infrastructure and the provision of related services (irrigation, water supply, and hydropower) in arid Central Asia. This article discusses the current situation in water security realities in the context of climate change. Dam safety, groundwater, and return flows will be discussed as vital adaptation and mitigation options. Energy efficiency is an essential element for resiliency at the operational level of water management. In addition, this article sheds light on successful examples of management of shared irrigation infrastructure on transboundary watercourses, which is a prerequisite for regional stability and prosperity. This research contributes to the construction of an agenda on the process of climate change and adaptative water resources management in Central Asia.