Context Hill stations are known for their favorable cool climate and natural environments which generate valuable ecosystem services that benefit the local population, tourists and visitors. However, rapid urbanization threatens the sustainability of these highly valued fragile landscapes. Objectives We aim to characterize and quantify the changes in the landscape patterns and ecosystem service values (ESVs) of Baguio (Philippines), Bogor (Indonesia), Dalat (Vietnam), and Pyin Oo Lwin (Myanmar), and discuss their implications to landscape sustainability. Methods We used remote sensing imagery to map land-use/cover (2001 and 2014), and spatial metrics and gradient analysis to characterize the changes in landscape pattern. We employed a benefit transfer method to estimate the changes in ESV and human-to-ESV ratio. A land-change model was used to simulate different scenarios of future built-up expansions (2014-2030). Results The landscapes of Dalat and Pyin Oo Lwin are becoming more fragmented, while those of Baguio and Bogor are getting more aggregated. Dalat had the highest decrease (absolute change) in ESV and H-ESV ratio, while Bogor had the highest percentage decrease (2001-2014). Conclusions Rapid urbanization has been a major factor in the landscape transformation of Baguio, Bogor, Dalat and Pyin Oo Lwin. If the current built-up expansion rate will speed up, the decline in future ESV and H-ESV ratio (2014-2030) will be higher than if the rate will continue or slow down. Unless the concept of landscape sustainability is taken seriously in landscape and urban planning, the respective 'values' of these precious hill stations will become less and less.