Changes in the ecological system, such as climate change, and changes in the social system, such as political and economic transformation processes, put water governance regimes under pressure. These regimes must either have at their disposal the needed resilience to cope with these changes and adapt or face the need to transform into another regime configuration which is better suited to cope with these changes. These options entail different levels of institutional continuity and change. Three types of balances between institutional continuity and change in social-ecological systems are elaborated: persistence, adaptive change and transformative change. This paper addresses the challenge of water sector institutions to provide for continuity on the one hand while meeting the need to change and adapt to new circumstances (such as climate change or political and economic transformation) on the other hand. Uzbekistan, which has accumulated intense pressure for change both in the social and the ecological system, serves as a case study. Highly unsustainable use of water resources and cotton monoculture put high pressure on the ecological system. One of the consequences, the desiccation of the Aral Sea, has major negative repercussions in the social system (increasing unemployment and decreasing health status of the population). Since the breakdown of the Soviet Union political and economic reforms have taken place rather reluctantly and have not triggered comprehensive changes in the water governance regime. Minor changes have been introduced at the local level, but the system has not yet departed from its unsustainable path of development. The paper concludes that the Uzbek water sector is rather resistant to change and comprises only a low level of institutional resilience. By applying the concepts of adaptive cycles and panarchy to institutions and water governance reform processes in Uzbekistan some drivers of these processes are identified.