Urban development is a well-known stressor for stream ecosystems, presenting a challenge to managers tasked with mitigating its effects. For the past 20 y, streamflow, water quality, geomorphology, and benthic communities were monitored in 5 watersheds in Montgomery County, Maryland, USA. This study presents a synthesis of multiple studies of monitoring efforts in the study area and new analysis of more recent monitoring data to document the primary lessons learned from monitoring. The monitored watersheds include a forested control, an urban control with centralized stormwater management, and 3 suburban treatment watersheds featuring low-impact development and a high density of infiltration-focused stormwater facilities distributed across the watershed. Treatment watersheds were monitored before development, during construction, and after development. Monitoring was initiated to inform adaptive management of stormwater and impervious cover limits within the study area, with a focus on the impacts of distributed stormwater management. Results from our synthesis indicate that distributed stormwater management is advantageous compared with centralized stormwater management in numerous ways. Hydrologic benefits were greater with distributed stormwater infrastructure, demonstrating the ability to mitigate runoff volumes and peak flows and, for small storms, replicate predevelopment conditions. Baseflow temporarily increased during the construction phase in the treatment watersheds. Water-quality benefits were mixed, with declines in baseflow nitrate concentrations but limited changes to nitrate export and increases in specific conductance after development. Substantial topographic changes occurred during construction in the treatment watersheds, including changes within the riparian zone, despite riparian buffer protections. Ecological monitoring indicated that even though index of biotic integrity scores rebounded in some cases, sensitive benthic macroinvertebrate families did not fully recover in the treatment watersheds. Lessons learned from this synthesis highlight the importance of tracking multiple indicators of stream health and considering past land use and that more stormwater facilities distributed across the watershed is beneficial but cannot mitigate the effects of all urban stressors on aquatic ecosystems.