This work explores the social, institutional, and technical landscape shaping the implementation of Nature-based Solutions (NBS) and innovative water management approaches across the Macaronesian archipelagos. Building on the region’s shared environmental challenges and unique governance contexts, the study aims to identify the barriers, challenges, and opportunities that influence the uptake of NBS in Macaronesia and in similar island analogues. To achieve this, relevant scientific research and examples of best practice from Europe and beyond are reviewed and consolidated, providing a foundation for contextual analysis. The work further defines key parameters that underpin successful participatory water governance, focusing on models that promote collaboration, transparency, and shared decision-making among institutions, experts, and citizens. A participatory water governance framework is developed to reflect these principles, integrating innovative co-management and co-decision-making mechanisms tailored to the realities of Macaronesian islands. The framework is informed by a comprehensive assessment of the legal and policy context in each study area, together with detailed stakeholder analysis and mapping to identify key actors, institutional linkages, and local influencers shaping water governance processes. Empirical data were collected through focus groups and semi-structured interviews with stakeholders from each island and demonstrator site, offering valuable insights into local perceptions, experiences, and priorities. To complement this qualitative understanding, a Macaronesia-wide citizen survey conducted in two native languages and examined broader public perceptions of climate resilience, groundwater resources, and NBS feasibility. Together, these activities provide an integrated understanding of social acceptance, institutional readiness, and perceived challenges and opportunities for NBS across the four archipelagos.