Groundwater use has significantly increased in the rapidly urbanising city of Kumasi, Ghana. But there is a lack of understanding of whether the groundwater system can sustain the growing demand in the future amidst climate change and rapid urbanisation. Using remote sensing datasets and a water balance approach, this study estimated the groundwater recharge and assessed how urbanisation has affected its groundwater sustainability. Sustainability is investigated by comparing multi-annual groundwater withdrawals to long-term average annual replenishment. Results show that while groundwater recharge has decreased by 80% from 1986 to 2020, mainly due to substantial (63%) loss of permeable land, groundwater consumption has seen a six-fold increase. Groundwater consumption in 2020 exceeded the long-term average groundwater recharge by 2.2Mm³, suggesting that the current groundwater use trends are unsustainable for future ground-water availability. Under a ‘business-as-usual’ scenario, a four-fold increase in groundwater consumption is predicted by 2050 while climate change and land-cover changes may reduce groundwater recharge by 10% and 55% respectively. Practical measures such as promoting artificial groundwater replenishment approaches, adopting low-impact development and instituting demand management measures must be implemented in the Metropolis. This should be informed by further studies to ascertain the exact condition of the groundwater.