Mountains occupy 24% of the global land surface area and are home to 12% of the world’s population. They have ecological, aesthetic, and socioeconomic significance, not only for people living in mountain areas, but for those living beyond. Mountains need specific attention for their contribution to global goods and services, especially by developing and implementing mountain specific policies. Conservation policies have evolved from the protection of charismatic species, to habitat and ecosystem/landscape conservation, and, finally, to people-oriented conservation approaches. This paper, with particular reference to paradigm shifts in the Hindu Kush-Himalayan (HKH) region, discusses the evolution of conservation policies, developments in conservation practices, the status of protected area management, wetland conservation initiatives and the landscape approach, community-based conservation initiatives, and the convergence of policies and practices. In the HKH region, conservation efforts now adopt participatory approaches, implement policies of decentralised governance for biodiversity management, and empower local communities in biodiversity management. The paradigm shift in the policies and practices related to conservation has been gradual and has included the acceptance of communities as an integral part of national level conservation initiatives, together with the integration of many global conventions. There are many successful pilots in the HKH region that deserve upscaling by the countries from the region. Realising the importance of mountains as hotspots of biodiversity, and due to their role as providers of global goods and services, the Convention on Biological Diversity adopted the Programme of Work on Mountain Biodiversity. Such a decision specific to mountains provides enormous opportunities for both conservation and development. Recent challenges posed by climate change need to be integrated into overall biodiversity conservation and management agendas, especially in mountain areas. The HKH region has been identified as a blank spot for data by the Inter-Governmental Panel on Climate Change, indicating the need to develop regional database and sharing mechanisms. This is a tall task, but one that holds enormous opportunity for the HKH countries and institutions with regional mandates to address the emerging challenges of climate change on biodiversity conservation by reducing scientific uncertainty.