Cotton is the most important fiber crop in the world for the fashion industry, national economies, and millions of farmers worldwide. Severe soil degradation as a result of long-term use of intensive agricultural practices is a serious challenge to future production as well as meeting global climate and nature targets. Fashion companies are responding to the realization that their dependence on soil and agriculture for raw materials is under threat. With total cotton production projected to grow, it is critical that cotton cropping systems are carefully managed to preserve the health and productivity of land, sustain livelihoods of growers and value chain actors, and build resilient supply chains in the face of climate change. This paper presents a review of soil conservation research in cotton-based systems, with the objective of informing the development of site-specific approaches to sustainable agriculture and regenerative land management.