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The small and medium-sized river basins along southeast coast of China hold comparatively abundant water resources. However, the rapid resources urbanization in recent years has produced a series of water problems such as deterioration of river water quality, water shortage and exacerbated floods, which have constrained urban economic development. By applying the principle of triple supply-demand equilibrium, this paper focuses on the estimation of levels of water supply and demand in 2030 at different guarantee probabilities, with a case study of Xiamen city. The results show that water shortage and inefficient utilization are main problems in the city, as the future water supply looks daunting, and a water shortage may hit nearly 2 × 108 m3 in an extraordinarily dry year. Based on current water supply-demand gap and its trend, this paper proposes countermeasures and suggestions for developing and utilizing groundwater resources and improving the utilization rate of water resources, which can supply as a reference for other southeast middle-to-small-sized basin cities in terms of sustainable water resources and water environment protection.