Conventional agriculture has made the search for sustainability urgent, more so with regards to climate change. This has extended to the grape and wine industry, an important industry in South Africa in terms of labor employment and foreign exchange. This paper aims to review the current state of knowledge with regards to the three pillars of sustainability and with regards to climate change. In order to understand sustainability in South Africa, a historical context is needed, because the welfare of farm workers still retains vestiges of past Apartheid. Ecological responsibility and higher profits are the main reasons for sustainable practices. Additionally, water use, chemical use, and soil erosion are important environmental sustainability concerns. With regards to climate change, in terms of economic sustainability, there will be winners and losers and social sustainability issues will intensify as changes occur in farms. Table grape producers are relatively more profitable than wine grape producers. Furthermore, pest, disease, irrigation pressure will worsen as the climate warms. However, there are long- and short-term adaptation strategies such as changes in viticulture practices and grape cultivars, respectively, to stem the effects of climate change, but this may be stymied by cost and farmers’ perceptions of climate change.