Sustainable use of groundwater in the hydrothermal area of Viterbo (Central Italy) was analyzed. In this area, multipurposes utilization of groundwater coexists: several thermal springs and wells supply spas and public pools, cold and fresh water is used for irrigation and drinking‐water. Starting from theoretical concepts, a management plan has been developed to ensure groundwater sustainability in response to the increased demand of withdrawal from thermal wells, by integrating previous hydrogeological studies, new investigations and a new finite‐difference model. The most stringent constraints considered are: to maintain the quality of thermal and fresh waters, to limit the effects on the hydraulic equilibrium existing between overlapping aquifers, to ensure a significant flow to the natural thermal springs and the quality and flow rate of the spring used for drinking purposes. The practical approach included identification of the maximum pumping rate from the wells of the spas, analysis of the response time of the system under development and drafting of a safeguard and monitoring plan. The case examined takes into account the complexity of the task in defining practical measures for groundwater management on the basis of theoretical concepts of its sustainable use. A participative approach among the different water decision‐makers and adaptive management in the use of groundwater resources with different quality represent the key points to overcome conflicts between different users, with the awareness of the ineludible uncertainties of the hydrogeological model.