Coastal regions are rich in cultural heritage due to their historical significance as hubs of human activity and play a vital role in enhancing local economies through tourism. The intersection of natural beauty and historical importance creates unique and valuable cultural landscapes. However, these historical sites face risks from natural and human impacts, including climate change (CC), rising sea levels, and industrial development. The Mediterranean coastal regions are rich in cultural heritage, reflecting millennia of human history, diverse cultures, and significant historical events. Therefore, this research focuses on the complex interdependencies between coastal vulnerability, sustainable tourism, ecosystem services, and erosion phenomena due to CC. Recent research shows climate change threatens Mediterranean cultural heritage, with up to 30% of African sites predicted to be at risk by 2050, a 25% increase in vulnerabilities at Nora, Sardinia, and 40% of sites in Basilicata, Italy, at risk from erosion. To assess the susceptibility of coastal heritage sites to climate impacts and develop adaptive strategies for conservation, methodologies such as remote sensing, GIS, 3D photogrammetry, and stakeholder engagement are employed. These approaches help analyze historical and future shoreline changes, air pollution effects, and ecosystem services, offering comprehensive insights into integrated coastal zone management and sustainable development. This work aims to provide valuable recommendations for policymakers, heritage managers, and stakeholders, contributing to the integrated management and preservation of coastal heritage sites in the face of growing environmental challenges.