Mountainous regions typically exhibit a strained relationship between humans and the land, with noticeable spatial differences in the supply and demand of ecosystem services (ESS and ESD, respectively). ESS and ESD display varying characteristics at different spatial scales. Research on ESS and ESD at multiple scales can aid regional development and efficient ecosystem management. However, the current research focuses on ESS and neglects the ES characteristic changes at different scales. This study concentrates on the Hengduan Mountain region in southwest China. It evaluated ESS and ESD, analyzed the spatial matching relationship, and proposed a corresponding development strategy. The results demonstrated four key findings. First, ESS displayed an inverse spatial distribution on the two scales and was lower in the north and higher in the south at the raster scale. Over the period 2000–2020, ESS exhibited a pattern of initial increase, followed by a decrease, albeit with varying spatial patterns. Changes in land use primarily drove these ESS changes. Second, ESD increased from northwest to southeast on both scales and showed a rising trend over time. Third, at the grid scale, the low supply and low demand (L-L) region is primarily situated in the northwestern part, and it is crucial to prevent grassland degradation and manage grazing intensity. The low supply and high demand (L-H) region is located in the southeast, where the protection of cultivated land, along with comprehensive control of rocky desertification and debris flow, should be prioritized. High supply and low demand (H-L) are found in the northern mountain area, where paying attention to soil erosion control is essential. For areas with high supply and high demand (H-H) types, efforts should be directed toward maintaining forest habitat integrity. Fourth, on the county scale, L-H types should focus on realizing the ecosystem service value and implementing ecological agriculture. H-L counties can appropriately develop economic activities. Simultaneously, ecological compensation should be conducted among counties.