Global changes and human activities have significantly altered water cycle processes and water resource patterns in inland river basins in arid zones. New tools are needed to conduct more comprehensive and scientific assessments of basin water cycle processes and water resource patterns. Based on GRACE satellite and Landsat data, this study investigated terrestrial water storage changes and surface water area in the Shiyang River Drainage Basin from 2002 to 2021. It explored the effects of climate change and water conservancy construction on terrestrial water storage changes in the basin. The results of the study show that, although the surface water quantity in the Shiyang River basin has increased in the past 20 years, the overall decreasing trend of terrestrial water storage in the basin of the Shiyang River has an interannual decreasing rate of 0.01 cm/a. The decreasing trend of water storage in the midstream and downstream areas is more prominent. The change in precipitation controls the change in water storage in the Shiyang River Drainage Basin. Artificial water transfer has changed the spatial distribution of water resources in the basin of the Shiyang River. However, it still has not completely reversed the trend of decreasing water storage in the middle and lower reaches of the Shiyang River.