Meeting the growing demand for food in the future will require adaptation of water and land management to future conditions. We studied the extent of different adaptation options to future global change in the Mediterranean region, under scenarios of water use and availability. We focused on the most significant adaptation options for semiarid regions: implementing irrigation, changes to cropland intensity, and diversification of cropland activities. We used Conversion of Land Use on Mondial Scale (CLUMondo), a global land system model, to simulate future change to land use and land cover, and land management. To take into account future global change, we followed global outlooks for future population and climate change, and crop and livestock demand. The results indicate that the level of irrigation efficiency improvement is an important determinant of potential changes in the intensity of rain-fed land systems. No or low irrigation efficiency improvements lead to a reduction in irrigated areas, accompanied with intensification and expansion of rain-fed cropping systems. When reducing water withdrawal, total crop production in intensive rain-fed systems would need to increase significantly: by 130% without improving the irrigation efficiency in irrigated systems and by 53% under conditions of the highest possible efficiency improvement. In all scenarios, traditional Mediterranean multifunctional land systems continue to play a significant role in food production, especially in hosting livestock. Our results indicate that significant improvements to irrigation efficiency with simultaneous increase in cropland productivity are needed to satisfy future demands for food in the region. The approach can be transferred to other similar regions with strong resource limitations in terms of land and water.