Agriculture in the Upper Indus Basin largely depends on the cryosphere, and cultivation is possible only through irrigation. The agriculture system, however, faces challenges in terms of climate, extreme events, water scarcity, and other socioeconomic conditions. Hence, a scoping review was conducted to identify the irrigation systems and coping mechanism in the 4 valleys of the basin. Centuries-old irrigation canals, water distribution, management systems, and coping mechanisms are in place. Adaptation strategies are managed by communities, and some are established and supported by government and development organizations. Successes, in terms of increased income, crop yields, and cost, are widely reported; however, evidence of their efficiency and sustainability is scarce.