Ecosystem-based approaches for climate change adaptation are promoted at international, national, and local levels by both scholars and practitioners. However, local planning practices that support these approaches are scattered, and measures are neither systematically implemented nor comprehensively reviewed. Against this background, this paper advances the operationalization of ecosystem-based adaptation by improving our knowledge of how ecosystem-based approaches can be considered in local planning (operational governance level). We review current research on ecosystem services in urban areas and examine four Swedish coastal municipalities to identify the key characteristics of both implemented and planned measures that support ecosystem-based adaptation. The results show that many of the measures that have been implemented focus on biodiversity rather than climate change adaptation, which is an important factor in only around half of all measures. Furthermore, existing measures are limited in their focus regarding the ecological structures and the ecosystem services they support, and the hazards and risk factors they address. We conclude that a more comprehensive approach to sustainable ecosystem-based adaptation planning and it’s systematic mainstreaming is required. Our framework for the analysis of ecosystem-based adaptation measures proved to be useful in identifying how ecosystem-related matters are addressed in current practice and strategic planning, and in providing knowledge on how ecosystem-based adaptation can further be considered in urban planning practice. Such a systematic analysis framework can reveal the ecological structures, related ecosystem services, and risk-reducing approaches that are missing and why. This informs the discussion about why specific measures are not considered and provide pathways for alternate measures/designs, related operations, and policy processes at different scales that can foster sustainable adaptation and transformation in municipal governance and planning.