The frequency of extreme weather events has increased in the latest years in Europe. The recent consecutive droughts caused severe damage in many sectors and underlined the demand for adaptation. There is a need for a better understanding of the response of ecosystems to climate change and the consequences for key ecosystem services, such as water supply and carbon sequestration, at a local and regional scale. This paper aims to support decision-making for climate adaptation in a low-mountainous region of central Germany. We analysed the temperature and precipitation trends and drought conditions. The response of two key services (surface water provision and carbon sequestration) to droughts is estimated using an ecosystem service model. The spatially averaged water yield, net ecosystem productivity (NEP), and soil moisture are assessed and compared for the five worst droughts with long-term averages to identify the vulnerable areas and ecosystems. The temperature increased on seasonal and annual scales, while precipitation decreased in some areas in summer and increased in winter and annually. The standardised precipitation-evapotranspiration index (SPEI) showed worsening drought conditions, especially after the late 1980s. Droughts caused a reduction of water yield by 54%, NEP by 18%, and upper zone soil moisture by 13%. The impacts varied spatially, with the central region being worst affected, while the southern part was relatively more resilient. Adaptation is urgently needed to reduce drought risks and enhance climate resilience. Adaptive measures can include amending crop rotations, introducing more drought-tolerant varieties, upgrading agriculture and food industry technology, increasing mixed forests, and reducing non-native tree species.