The growth in the number of studies applying and expanding the concepts of the water footprint and virtual water trade in Spain has generated a wealth of lessons and reflections about the scarcity, allocation, productive use, and management of water from the viewpoint of a semi-arid country. This paper reviews the evolution of this research field in Spain since its introduction in 2005 and reflects on its main contributions and issues of debate. It shows how these concepts can be useful tools for integrated water accounting and raising awareness, when used with certain precautions: (1) Supply-chain thinking, taking into account value chains and the implications of trade, generally ignored in water management, can help to address water scarcity issues and sustainable water use. (2) Green water accounting incorporates land use and soil management, which greatly influences hydrological functioning. (3) The grey water footprint indicator analyzes pollution from an ecosystem point of view and facilitates the understanding of the water quantity and quality relationship. (4) Apparent water productivity analysis, innovatively incorporated into Spanish studies, considers the economic and social aspects associated with water use. However, the decision-making context should be broader, contextualizing and complementing water information with other indicators.