New Mexico’s high-altitude region supports several medicinal plants adapted to grow in challenging environments. This chapter explores the botany, conservation, and cultivation of prominent herbs that exemplify major categories of medicinal herbs and highlights their significant medicinal, ecological, and economic value. These include saffron (Crocus sativus), a non-native that shows promise in New Mexico, and native New Mexican herbs, osha (Ligusticum porteri), a high elevation forest perennial, ephedra (Ephedra viridis), a shrub found in high aridlands, cota (Thelesperma megapotamicum), a perennial gathered in lower elevation aridlands, and yerba mansa (Anemopsis californica), a perennial found and can be further developed within traditional irrigated valleys. Saffron, known for its vibrant color and health benefits, thrives in well-drained soil and cool temperatures. The native herbs such as osha, ephedra, cota, and yerba mansa are integral to Indigenous healing practices and continue to be vital for local New Mexico cultures. The ecological conservation of these important medicinal plants is becoming increasingly endangered by impacts from climate change, habitat destruction, overexploitation (harvesting), the introduction of invasive species, and pollution. Community participation in conservation has long been essential for saving these species, allowing communities to use traditional ecological knowledge, cooperate on a communal basis, and participate in education and awareness so that several local communities are interested in the conservation aspect of such efforts. Eco-tourism and sustainability-based commerce provide supplementary economic incentives to conservation objectives. The cultivation of saffron and native herbs requires local traditional knowledge, modern agricultural practices, habitat restoration, and sustainable farming. Sustainable farming practices such as crop rotation, polyculture, permaculture, and water-saving irrigation methods are indispensable for reducing environmental degradation and promoting long-term agricultural abundance. Saffron and native herbs may offer substantial agricultural benefits in the state of New Mexico, providing an economic boon for local growers. Local farmers could benefit from this potential economic boom while preserving these amazing plants by promoting sustainable harvesting. This provides a basic structure for the sustainable utilization of high-altitude medicinal plants and their various operations in terms of botany, conservation, and cultivation practices. Since the arid regions that host saffron and these native New Mexican herbs are fragile, understanding and respecting their ecosystem will help preserve them as medicine and cultural heritage identity for future generations.