Soil health is a priority in European policies due to land degradation and climate change, with Mediterranean vineyards being especially vulnerable because of low organic matter and erosion risk. To improve sustainability, cover crops are increasingly used as an alternative to conventional tillage with bare soils. This study assessed the effects of different ground cover strategies on soil health, grape production, and biodiversity in a Vitis vinifera cv. Tempranillo vineyard (D.O. Ribera del Duero, Spain). Four soil management systems were compared in 2021–2022: conventional tillage (CT), natural ground cover (NGC), a sown grass–legume mixture (SGC), and a sown grass–flower mixture (FGC), in a randomized block design with four replicates. Surface soils (0–20 cm) were sampled in spring 2022 and analyzed for pH, EC, organic matter, total nitrogen, soluble nutrients, microbial biomass, and enzymatic activity, as well SPAD measurement to monitor plant development and yield and grape quality. Green covers reduced grape yield but improved quality, notably by increasing anthocyanin content in must. They also enhanced vineyard biodiversity and slightly raised soil organic carbon. However, they depleted available nutrients, particularly nitrates, and showed only limited effects on soil biological properties such as enzyme activities. Overall, cover crops promoted ecosystem services but required trade-offs with yield and soil nutrient availability.