The changes of regional landscape patterns and evolution trend of ecosystem health are significant for regional ecological security in the Western Qinling Mountains due to its fragile environment and increasing human-land conflict. This paper discussed the spatial and temporal evolution of landscape pattern and ecosystem health in the Western Qinling Mountains from 2000 to 2018. Landscape pattern in the Western Qinling Mountains was explored using remote sensing data from 2000 to 2018. The Vigor-Organization-Resilience model, the ecosystem service capacity and human disturbance were used to study the ecosystem health of the Western Qinling Mountains. The forest, cropland and grassland were three dominant landscapes in the study area. The transfers of landscape types mainly occurred in the mutual conversion of the three types from 2000 to 2018. In addition, the area of settlement has been increasing rapidly. The expansion of landscape types in the Western Qinling Mountains was realized through a large number of small-scale scattered expansion patches. There was a turning point in the landscape heterogeneity and fragility of the Western Qinling Mountains in 2005 and the landscape types showed a balanced development trend due to the strengthening of ecological protection. More than 60% of the ecosystem landscapes in the study area were in a healthy state, and the ecosystem health index of the Western Qinling Mountains increased from 2000 to 2018. However, the high-altitude ecologically fragile areas of the Western Qinling Mountains and the marginal zone of the Qinling Mountains and the Loess Plateau were in sub-health or unhealthy state. The research results are of great significance for the ecological protection and management of the ecologically fragile and sensitive zone in the Western Qinling Mountains and in prove the stability of its ecosystem.