Groundwater resources in major Asian cities, including Bangkok and its vicinity, Ho Chi Minh City, Kathmandu Valley, and Lahore, confront escalating challenges due to climate change and human development. Over-extraction has led to groundwater depletion, causing socio-environmental and economic issues. This study investigates the combined impacts of climate change and urban development on groundwater resources and assesses the resilience of these cities’ groundwater systems that are essential for sustainable management strategies. Employing a model-based approach, the study analyses climate and land use changes, groundwater recharge, levels, and resilience. Three land-use and extraction scenarios—high, medium and low—are examined to evaluate their effects on groundwater. The results suggest that all four Asian cities are expected to be warmer in future. Results predict warmer conditions across all cities, with Ho Chi Minh City experiencing the most significant temperature increases. All cities anticipate increased rainfall under both Representative Concentration Pathway (RCP) scenarios, notably Bangkok. Groundwater recharge is projected to decrease in high urbanisation settings and both RCPs, contrasting with a rise in low to medium urbanisation contexts. Under a high urbanisation scenario, the outskirts of all four Asian cities are resilient to climate change and human development, whereas the centre or urban areas are not resilient.