Although palustrine wetlands cover only about 6% of the earth’s surface, they are among the most productive and socio-economically valuable ecosystems globally. However, these ecosystems are facing various threats. The current study uses literature and field observations to explore the montane palustrine wetlands of Lesotho, in terms of their distribution, coverage, vegetation, ecosystem services, status, major threats and conservation. The study found that despite occurring throughout the country, the highest density of the wetlands is associated with the central and eastern parts, and generally declines towards the south and west as the rainfall decreases and the altitude becomes lower. The wetlands are rich in plant diversity and deliver various ecosystem services, including water, livestock grazing, harvestable resources, carbon storage and crop cultivation. Therefore, these wetlands play an important role at the local, national and regional scales and form an important water resource for Lesotho, South Africa and Namibia. Despite their value, some of the wetlands have been lost and the condition of those remaining is declining, mainly due to anthropogenic factors. Nevertheless, various conservation and restoration activities have been implemented in an attempt to conserve and manage these ecosystems. Despite these efforts, wetland loss and degradation continue, to the detriment of wetland biodiversity and ecosystem service delivery. Thus, this study recommends the scaling-up of the conservation efforts, as well as mainstreaming wetland conservation and management, including emphasising the wise use of these systems. Emphasis should be placed on regulating livestock grazing and trampling, harvesting of natural resources, infrastructure development and cultivation in the wetlands.