Agriculture and water resources are two strategic sectors vulnerable to climate change and climate variability in Central America. The integration of soil and water conservation (SWC) techniques into small-scale hillside farming systems has been considered in recent strategies of adaptation. Several SWC techniques have been adopted by small-scale hillside farmers. The most frequently adopted techniques are those involving biomass management. Crop residue management, no-slash-and-burn and living hedgerows of several plant species are some examples. The costs of implementing several SWC techniques have been estimated, but the cost-benefit analysis considering soil erosion reduction, water capture and food crop yields needs more in-depth studies. Interviews with small-scale farmers from several countries led to the conclusion that adoption of SWC techniques has contributed to increases of food crop yields, or in the worst of cases provided acceptable yields during severe climatic events, particularly droughts. These effects are important for food security and reduced off-site impacts in the region. The costs of adopted SWC techniques have been estimated in the region, but the contribution of different studies to cost-benefit analysis needs further analysis. It is widely accepted that SWC techniques contribute to erosion reduction, water capture and maintenance of soil productivity, but the cost-benefit analysis for off-site positive impacts needs to be integrated into the equation.