Wetlands within dryland regions are highly sensitive to climate change and human activities. Based on three types of land use data sources from satellite images and a spatial data analysis, the spatiotemporal characteristics of wetland evolution in China's drylands and their relationship with human interference and climate change from 1990 to 2020 were analyzed. The results were as follows: (1) The wetlands within China's drylands expanded, including rivers, lakes, and artificial wetlands, apart from marshes, which shrunk. Meanwhile, wetland fragmentation increased, with rivers being particularly severely fragmented. (2) Temperature and precipitation showed an increasing trend from 1990 to 2020 in China's drylands. Lakes and rivers expanded with regional differences due to the uneven distribution of precipitation and rising temperature. (3) Human activities, more than climate change, became the key driving factor for the changes in wetland patterns in China's drylands. The increased areas of farmland and grassland along with increased levels of drainage and irrigation activities led to the shrinkage of marshes and the fragmentation of rivers. The increase in the number of artificial reservoirs was the main reason for the expansion of artificial wetlands. This study clarifies the specific driving factors of different types of wetlands within China's drylands, which is of great use for better protecting wetlands and the gradual restoration of degraded wetlands.