The aircraft Environmental Control System (ECS) enables the aircraft to maintain a comfortable and safe environment for its passengers throughout its operating envelope. The Pressurised Air Conditioner (PACK) is the heart of the ECS, and is composed of multiple sub-systems: heat exchangers, valves, compressor, turbine, and a water separator. The PACK’s principle function is to enable conditioning of the hot, high pressure bleed air from the engine or APU, for temperature, pressure and humidity against the cabin requirements. The operation of the PACK is governed by a control system which has the ability to mask degradation in its component during operation until severe degradation or failure results. The required maintenance is then both costly and disruptive. The PACK has been reported as major driver of unscheduled maintenance by the operators. The aviation industry is currently proactively exploring innovative health management solutions that aid the maintenance of aircraft key systems based on predictive based maintenance approaches using online condition monitoring techniques. This paper presents a comprehensive review of the simulation and diagnostic methodologies applicable to fault diagnostics of the ECS PACK. The existing literature suggests that model-based and data-driven methods are effective for conducting fault detection and isolation of the PACK system. The conceived findings indicate that the model-based diagnostic approach have been extensively employed to conduct PACK diagnostics at component level only. Their successful implementation requires robust experimental verification and validation against the actual data under healthy and faulty conditions. Although a substantial amount of work has been reported on developing first principles based simulation models and diagnostic strategies for the ECS, the acquired findings suggest that there is a compelling need for a verified and validated ECS simulation model to enable accurate PACK system-level diagnostics based on single and multiple component level degradation scenarios. It has also been identified that the existing literature lacks the evaluation of humidity regulation and the effect of the control system on the PACK performance characteristics. Finally, a taxonomy of diagnostic techniques and simulation models is compiled based on the available literature.