Modifications to land can serve to jointly reduce risks of floods and droughts to people and to ecosystems. Whether land modifications are implemented will depend on the willingness and ability of a diversity of actors. This article reviews the state of knowledge on land modification use in areas exposed to dual hydrologic risks and the land owners, managers, and users who directly make decisions about action on lands they control. The review presents a typology of land modifications and explains how land modifications interact with the hydrological cycle to reduce risks. It then addresses the roles and perspectives of the land owners, managers, and users undertaking land modifications, summarizing theories explaining motivations for, as well as barriers to and enablers of, land modification implementation. The analysis reveals geographical differences in narratives on land modifications as well as knowledge gaps regarding variation across actors and types of land modifications.