Model simulation plays a significant role in the water resources cycle, and the simulation accuracy of models is the key to predicting regional water resources. In this research, the Qianhe tributary at the Weihe River basin in Western China was selected as the study area. The tributary was divided into 29 sub-basins and 308 hydrological response units according to the spatial raster data and attribute data of the hydrology, meteorology, topography, land use, and soil types. On this basis, a soil and water assessment tool (SWAT) model for runoff simulation and evaluation of this region was established. A sensitivity test and parameter calibration were then executed on 15 parameters involved with surface runoff, soil flow, and shallow underground runoff. The simulation results demonstrate a calibration and verification error of 3.06–10.08%, with very small uncertainties throughout the simulation, whereas they exhibit relatively large errors in the simulation of the dry period (winter) but, in contrast, quite small errors in the rainy period (summer). In addition, the simulated runoff with a low value is overestimated. When the annual, monthly, and daily runoff are 4–13.5 m3/s, 4–69.8 m3/s, and 40–189.3 m3/s, respectively, the relative error is smaller, and the simulation results are more accurate. The sensitive parameters predominantly affecting the runoff simulation of the basin include soil evaporation compensation, runoff curve coefficient, vegetation transpiration compensation, and saturated hydraulic conductivity in this region. In the case of hypothetical land use change scenarios, we observe a great reduction in simulated runoff in arable land, woodland, and grassland, while we observe an increment in construction and residential land and wasteland. The annual and monthly runoff are increased by above 54.5%. With the increase in cultivated land and forestland, the annual and monthly runoff decrease by 24.6% and 6.8%, respectively. In the case of hypothetical scenarios under 24 climate combinations, if the precipitation remains unchanged, the increase and decrease in temperature by 1 °C leads to a decline and increment of runoff by −0.72% and 5.91%, respectively. With regard to the simulation for the future under the RCP2.6 and RCP8.5 climate scenarios, downscaling was employed to predict the runoff trend of the future. In short, this study provides a method for runoff inversion and water resources prediction in small mountainous watersheds lacking hydrological and meteorological observation stations.