Understanding the potential association between the urbanization process and regional water shortage/pollution is conducive to promoting the intensive utilization of local water resources. In this study, the water footprint model was used to estimate water utilization status in terms of both water quantity (virtual water footprint (VWF)) and water quality (grey water footprint (GWF)) in the Beijing–Tianjin–Hebei region (China) during 2004–2017. Their potential coordination relationship with the local urbanization process represented by the gross domestic product (GDP), population (POP), and built-up area (BA) was examined using the Tapio decoupling model. The results showed that from 2004 to 2017, (1) VWF in Beijing and Tianjin showed non-significant decreasing trends, with reductions of 1.08 × 109 and 1.56 × 109 m3, respectively, while that in Hebei showed a significant increasing trend, with an increase of 5.74 × 109 m3. This indicated a gradually increasing water demand in Hebei and decreasing demand in Beijing and Tianjin. In all three regions, the agricultural sector accounted for a relatively high proportion of VWF compared to other sectors. (2) GWF in Beijing, Tianjin, and Hebei all showed declining trends, with reductions of 2.19 × 1010, 2.32 × 1010, and 1.66 × 1011 m3, respectively, indicating considerable local water quality improvement. The domestic sector contributed as the main component of GWF in Beijing, while agriculture was the main contributor in Hebei. The major contributor in Tianjin transitioned from the domestic (before 2015) to the agricultural sector. (3) We found good coordination between VWF and GDP in all three regions, as their local economic development was no longer overly dependent on water consumption. However, the expansion of urban built-up area or population would bring about accelerated depletion of water resources. (4) GWF in the three provinces showed good coordination with GDP, POP, and BA in most years, implying that the development of urbanization no longer strongly caused the pollution of water resources. In sum, policymakers should focus on improving agricultural irrigation efficiency and residents’ awareness of water conservation, so as to gradually achieve sustainable water resource management in the BTH region.