The Fujian coastal zone, a key region in China’s coastal belt, has experienced significant landscape and ecological changes due to intense human activities. Understanding the relationship between landscape patterns and ecological quality is critical for sustainable development and ecological protection. Taking the coastal cities, including Fuzhou, Xiamen, and Ningde in Fujian Province of China, as a case, the spatio–temporal changes in landscape patterns and the remote sensing-based ecological index (RSEI) during 2000 and 2020 were explored by the Google Earth Engine (GEE) cloud platform, and then their spatial relationships were identified through Pearson correlation analysis and bivariate spatial autocorrelation analysis. The findings reveal that (1) forest land was the dominant landscape in Fuzhou and Ningde, while cropland prevailed in Xiamen. Significant changes occurred in the land use landscape patterns of the three cities, mainly due to a substantial increase in the built-up land and varying degrees of reduction in arable and forest land. At the landscape level, both Fuzhou and Xiamen exhibited increased landscape fragmentation, while Ningde showed a trend of landscape aggregation; at the class level, forest land in Fuzhou and Xiamen exhibited increased fragmentation, whereas in Ningde, it showed an aggregation trend. (2) Between 2000 and 2020, the ecological–environmental quality of Fuzhou and Ningde continuously improved, while the improvement in Xiamen was less significant. Poor and fair ecological environments in the three cities were mainly concentrated in city centers and coastal zones, and areas of ecological quality degradation were primarily concentrated in coastal zones. (3) Correlation analysis indicates that, whether at the landscape level or the class level, the ecological quality of the three cities is significantly negatively correlated with the fragmentation index and significantly positively correlated with the aggregation index. Moreover, the positive correlation between ecological quality and the forest landscape aggregation index, as well as the negative correlation with the forest landscape fragmentation index, are both significantly stronger than those at the landscape level. As urbanization progresses, forest landscape fragmentation intensifies, especially in city centers and coastal areas, having a significant negative impact on ecological quality. These results highlight the importance of landscape pattern management in maintaining ecological quality. This paper provides insights for coastal cities on balancing urban development with ecological preservation in the context of rapid urbanization.