In the water sector, where resources extend across geographical and political boundaries, adaptation often involves decisions and actions by multiple stakeholders with differing shares in the costs and benefits of these initiatives. Hence the need for an economic approach that takes account of the distributional aspects of adaptation: stakeholder-focused CBA. In this study, we develop a stakeholder-based approach to CBA that involves primary stakeholders throughout the process from identifying adaptation strategies to assessing how their costs and benefits are distributed. Five case studies from representative low- and middle-income countries were selected to pilot the approach.