Rivers are the cultural, social and economic backbone of South Asia, and therefore, the focus of public, political and scientific debate. Himalayan glaciers are the source of numerous large Asian river systems, which support rich ecosystems and irrigate millions of hectares of fields, thereby supporting about a billion people who live in their catchments. Impacts of climate change in river systems are likely to have considerable social, economic, ecological and political implications. This paper reviews literature for three major glacier-fed river systems of South Asia—Brahmaputra, Ganga and Indus—to understand governance mechanisms for climate adaptation in the region. A systematic review methodology is applied to examine adaptation responses in the riparian countries of these Himalayan river basins in three different levels—policy objectives, institutions and practice. Using the “fit for purpose” governance framework, we try to examine how far or near is the region for operationalizing principles of adaptive governance.