Changes in land use patterns, types, and intensities significantly impact ecosystem services. This study follows the time series logic from history to the expected future to investigate the spatial and temporal characteristics of land use changes in Ezhou and their potential impacts on the ecosystem services value (ESV). The results show that the Markov–FLUS model has strong applicability in predicting the spatial pattern of land use, with a Kappa coefficient of 0.9433 and a FoM value of 0.1080. Between 2000 and 2020, construction land expanded continuously, while water area remained relatively stable, and other land types experienced varying degrees of contraction. Notably, the area of construction land expanded significantly compared to 2000, and it expanded by 70.99% in 2020. Moreover, the watershed area expanded by 9.30% from 2000 to 2010, but there was very little change in the following 10 years. Under the three scenarios, significant differences in land use changes were observed in Ezhou City, driven by human activities, particularly the strong expansion of construction land. In the inertial development scenario, construction land expanded to 313.39 km² by 2030, representing a 38.30% increase from 2020. Conversely, under the farmland protection scenario, construction land increased to 237.66 km², a 4.89% rise from 2020. However, in the ecological priority development scenario, the construction land area expanded to 253.59 km², a 10.13% increase from 2020. Compared to 2020, the ESV losses in the inertia development and farmland protection scenarios were USD 4497.71 and USD 1072.23, respectively, by 2030. Conversely, the ESV under the ecological protection scenario increased by USD 2749.09, emphasizing the importance of prioritizing ecological protection in Ezhou City’s development. This study may provide new clues for the formulation of regional strategies for sustainable land use and ecosystem restoration.