As the impacts of climate change and water demands from irrigation continue to increase in the Murray–Darling Basin, water for the environment is becoming more scarce and the ecological conditions of many wetlands is poor. With water scarcity, conservation triage is becoming an increasingly relevant management option for environmental watering of wetlands. However, triage is controversial; being considered contrary to current conservation objectives and practices. We assessed environmental watering at two Ramsar wetlands, Macquarie Marshes and Gunbower Forest, based on international environmental treaty obligations and domestic policy settings, changes to flow regimes, wetland condition and current management. Triage decision making was found to be in tacit use at Macquarie Marshes, based on ‘rules of thumb’ and experiential ecohydrological knowledge, whereas formal environmental watering planning formed the basis for triage decision making at Gunbower Forest. We developed a framework for conservation triage of wetlands in the Murray–Darling Basin to stimulate change in the decision context for wetland conservation and adaptation under climate change. Conservation triage entails reframing of relationships between people and nature and values, rules and knowledge used by stakeholders. Because water is the medium by which wetland conservation outcomes eventuate, trade-offs between competing water uses can be realised with the triage framework.