Arid inland basins represent critical hotspots of intensified conflict among water resources, ecological integrity, and economic development on a global scale. The coevolution of groundwater systems and land use patterns plays a pivotal role in shaping regional sustainability trajectories. This study synthesizes multi-source data spanning 2000 to 2020 from the Wuwei Basin, located within the Shiyang River watershed in China, to elucidate the synergistic dynamics between hydrological and land use transformations. Key findings reveal: (1) Around 2010, a significant structural shift in land use occurred, transitioning from production-oriented expansion to ecologically driven priorities. This shift was characterized by a reduction in cultivated land, increased utilization of artificial surfaces, and accelerated ecological restoration efforts. These changes were jointly influenced by enhanced water governance frameworks and spatial planning policies. (2) Groundwater levels exhibit marked spatial variability. While stability is maintained in piedmont and discharge zones, persistent overdraft has led to pronounced declines in transitional and distal recharge areas. This heterogeneity is primarily governed by the interplay of hydrogeological factors-such as recharge capacity and aquifer permeability-and anthropogenic pressures, including the extent of cultivated land and intensity of groundwater extraction. Notably, these patterns cannot be explained solely by the proportion of cultivated land or total extraction volumes. (3) A positive feedback mechanism-termed the "gain-loss regime shift"-has been identified in the discharge zone, where simultaneous increases in groundwater extraction and water-level recovery are observed. However, human activities have disrupted the natural coupling between precipitation and groundwater recharge, resulting in a significant attenuation of recharge rates (exceeding 80%). These findings offer a robust scientific basis for implementing spatially differentiated water resource management strategies and optimizing land use in arid basin environments. The implications extend beyond regional contexts, contributing to broader efforts in harmonizing human-environment interactions globally.