Intangible cultural heritage (ICH) reflects a region’s history and culture, serving as a significant indicator of regional identity and cohesion. The Grand Canal Basin in China is rich in historical traditions, containing a rich array of ICH resources. Analyzing the spatiotemporal distribution characteristics and influencing factors of ICH within the Grand Canal Basin of China can provide a scientific basis for developing cultural industries and promoting sustainable regional economic growth. This study employed GIS-based spatial analysis methods, including kernel density estimation, the mean nearest neighbor index, and standard deviation ellipse, to investigate the spatiotemporal distribution of 504 national-level ICH items (including extensions) in the Grand Canal Basin of China. The results demonstrate the significant spatial clustering of ICH, with concentrations in high-density regions, particularly at the northern and southern ends of the canal. There is significant regional disparity in the distribution of ICH, with an uneven quantity and structure, predominantly featuring traditional skills and traditional drama categories. The average centroid shift of ICH exhibits a north-to-south oscillatory trajectory. However, overall, it demonstrates a southward-moving trend. This study also underscores the impacts of urbanization, population density, economic development, and transportation infrastructure on ICH distribution. Among these factors, urbanization exerts the strongest influence on the spatial distribution of ICH. The impact of the natural environment is relatively minor; however, it remains a significant element that cannot be overlooked during development. This research offers valuable data and insights for local governments and institutions to formulate evidence-based strategies for the protection and sustainable utilization of ICH resources, promoting sustainable cultural and economic development in the Grand Canal Basin.