Water yam (Dioscorea alata L.) is an underutilized crop but plays a crucial role in food security of small and marginal rural families. For centuries, local farmers have planned agricultural production while conserving natural resources by adopting traditional knowledge (TK). This study aims to documents the importance of TK on water yam diversity, conservation and farming practices from the East Javanese community, a case study in Tuban Regency, Indonesia. The data collection was using a purposive sampling through interviews and direct participatory activities. Results showed that at least seven water yam local varieties were recognized with high tuber morphological variations, namely Uwi Bangkulit, Uwi Putih, Uwi Legi, Uwi Ungu, Uwi Sego, Uwi Klelet, and Uwi Randu. The variety naming mostly reflects distinct morphology and perceptual characteristics. The farmer’s reasons to cultivate variety are related to the economic value and consumable preference. Three farming systems were identified including home garden, dry land agriculture and agroforestry. The cultivation patterns are adjusted to the climatic and seasonal changes for many years, with good management practices from seed and soil preparation, planting and crop maintenance, to tuber harvest, storage and marketing. Miscellaneous uses of water yam are also documented for their sustainable livelihoods. This study can serve as a framework for decision-making at local and national level for conservation efforts and further development in cultivation management and utilization of water yam.