In large part driven by total maximum daily load (TMDL) mandates, the restoration community in the Chesapeake Bay region has been implementing novel best management practices (BMPs) and stream restoration designs in urban areas, such as regenerative stream/stormwater conveyance (RSC) structures and stream-wetland complexes (SWCs). However, the nutrient and sediment reduction efficiencies of these novel designs are virtually unknown, and the possibility of increasing riverine flow in the Chesapeake Bay watershed associated with climate change this century necessitates an evaluation of their performance to develop and utilize those that optimize reductions in nutrient and sediment fluxes. We compare pre- and post-construction loads (total nitrogen (TN), total phosphorus (TP), and total suspended solids (TSS)) from RSCs (i.e., upland BMPs) and a SWC (i.e., stream restoration) constructed at the outflow of a highly developed watershed in the Coastal Plain physiographic province of Maryland. The largest of the two RSCs performed best in relation to expected nutrient and sediment reductions because of superior water retention capability. By the length of river reach restored, the SWC attained from 79 to 88% of its N reduction TMDL goal, but only 19 to 23 and 2.7 to 3.1% for TP and TSS, respectively; by watershed area, % attainments of TMDL goals were much lower. Results indicate that SWCs have the potential to curtail N loading from developed catchments, but additional water quality benefits may be limited. Climate change projections indicate that there will be an increased frequency of larger-volume storms that will result in an increase in stormflow runoff from urban areas, and increased pollutant loads will likely curtail potential gains made by efforts to achieve TMDL goals. Given the large-scale implementation of BMPs currently underway to accommodate the Chesapeake Bay TMDL, the restoration community needs to adopt a concerted strategy of building climate resilience into many types of urban BMPs to help attain and maintain loads at TMDL levels in anticipation of a progressively wetter climate throughout this century.