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The global environmental crisis demands transformative approaches toward sustainability. Nature-based solutions (NbS) resonate strongly in science and practice, but their capacity to deliver transformative change has not been assessed. Here, we provide a conceptual framework to assess NbS under a transformative change lens and operationalize it through a dataset of 93 NbS implemented in mountain regions globally. The majority of NbS we assessed combine ecological and social elements with potential to deliver transformative change. These include various human values about nature and knowledge types, community engagement processes, and management practices such as restoration, ecosystem monitoring, and nature protection. We also found evidence that NbS can contribute to transformative change toward sustainable trajectories. We call for further research on transformative change in practice that supports the monitoring and evaluation of NbS on the ground.