This paper examines how indigenous peri-urban households in Wa, one of the fastest growing towns in Ghana are adapting to the effects of physical transformation of their environment. By analysing Landsat satellite images and using social research methods, the paper discusses the nature and extent of urban growth, its impact on peri-urban livelihoods, and the coping strategies of peri-urban households. Findings show that urban land in Wa increased by 5.73 times—from 5.75 km2 in 1986 to 32.93 km2 in 2016 with an annual growth rate of 5.9%. This growth led to the conversion of agricultural lands into residential and other uses. As a result, many indigenous peri-urban households are abandoning agriculture in search for urban-based employment as a safety net. The study recommends partnership between local government and landowners to identify and protect high potential agricultural lands in Wa; modernisation of the land governance and management processes in view of the loss of cultural and spiritual values associated with land; prioritisation of physical and spatial planning at the district level; and equipping indigenous peri-urban households with skills to assist them create sustainable livelihoods to compensate for the loss of their agriculture lands.