Karst is an important part of the surface earth system. Southwest China karst faces high pressure from agricultural activities and rocky desertification, the most serious eco-environmental problems in karst regions, as there is relatively less human and poverty pressure in the other karst regions of the world. Southwest China karst is the largest area of continuous poverty in China. In this study, we reviewed the progress on ecological conservation and restoration of China karst. For karst ecosystem conservation and restoration, the local and national Chinese governments have implemented a series of ecological restoration projects to combat rocky desertification and relieve poverty. Under the continuous support of scientific projects, researchers have been exploring the fundamental theories, treatment measures and technology, and industrial demonstration related to karst ecological restoration and rocky desertification treatment. China has achieved great progress on the karst ecosystem degradation mechanisms, rocky desertification treatment technology and measures, poverty alleviation with ecological restoration, karst landscape protection, and international karst research collaboration. All these achievements make China the leader of international karst research. Currently, rocky desertification in China is continuously decreasing with the implementation of large ecological restoration projects. However, intervention is facing new problems, such as the extensive investment and coarse subregions, difficulties for consolidation of restoration benefits, lack of sustainability for treatment, and lagged recovery of ecosystem services. Therefore, further ecological conservation and restoration in China karst should aim to enhance the sustainability of ecological restoration and pay more attention to the mechanisms and institution of recovery processes. For improving the quality and efficiency of rocky desertification restoration, we should highlight the promotion of karst ecosystem services and the consolidation of poverty relief in further ecological project implementation. It will provide scientific foundations for the implementation of the Beautiful China strategy and China's solutions for ecological restoration in other karst countries.