The use of soil conservation practices in wine grape production is becoming common throughout the world in response to an increased awareness of the value of soil health to maintain crop productivity and environmental quality. However, little information is available on the meaning of soil health within a viticultural context, and what soil properties should be targeted to achieve both the agronomic and environmental goals of wine grape producers. Conservation practices lead to increases in soil organic matter which may improve soil water retention, and increase soil C content therefore constituting a potential avenue to adapt to droughts and sequester C. Well-known management practices such as the use of cover crops, compost or no-till, although effective, seem to result in highly variable outcomes in soil organic matter and other soil health indicators. This variability is likely associated to the application of the practices in different soils and climates. Thus, integration of soil health building practices needs a thorough understanding of their efficacy under different conditions. Furthermore, additions of soil organic matter could trigger emissions of CO2 and N2O, a potent greenhouse gas that could represent a potential tradeoff of soil conservation practices. Finally, nutrient and water availability may be affected by the increase in soil organic matter having consequences for vine balance and grape quality.