To address the lack of spatiotemporal integrative analysis in studies on sustainable water resource utilization in Gansu Province and to provide scientific guidance for local water management and efficient use, this study employs the water resource ecological footprint and ecological carrying capacity models. Taking the period from 2014 to 2023 as the study interval, we conduct a quantitative assessment of sustainable water use in Gansu Province at both temporal sequences and spatial scales across prefecture-level cities, incorporating indicators such as ecological surplus/deficit and ecological pressure index. The results indicate that, temporally, the water ecological footprint of Gansu shows a decreasing-then-increasing trend, with an average ecological carrying capacity of 6.594 million ha, consistently remaining in ecological deficit and experiencing substantial ecological pressure, with agricultural water use identified as the primary pressure source. The water ecological footprint per 10,000 Yuan of GDP initially decreased and then increased, suggesting that the effectiveness of water-saving measures has lacked sustainability. Spatially, significant regional differentiation is observed: the water quantity ecological footprint is “high in Hexi, low in southeastern Gansu,” with expansion in high-value areas; although the water quality ecological footprint has generally declined, southeastern Gansu remains a core pressure zone. The Hexi water resource pressure belt continues to expand, indicating that while water use efficiency is improving across the province, ecological pressure is intensifying. The study highlights issues such as limited water endowment and highly water-intensive industries in Gansu, and proposes differentiated management and industrial optimization strategies to address challenges in sustainable water use, thereby providing a theoretical basis for scientific water resource management in the region.