The major towns in the district are Alexandra (the seat of local government), Cromwell, Roxburgh, Clyde and Ranfurly.

The current mayor is Tamah Alley, who succeeded her predecessor Tim Cadogan in late October 2024.

[2] Cadogan had resigned in 2024 prior to the 2025 New Zealand local elections to move to Wellington.

The results were 89.8% European (Pākehā); 9.5% Māori; 2.4% Pasifika; 4.5% Asian; 0.9% Middle Eastern, Latin American and African New Zealanders (MELAA); and 3.0% other, which includes people giving their ethnicity as "New Zealander".

[6] The Central Otago district has three towns with a population over 1,000: Cromwell (7,440), Alexandra (6,150), and Clyde (1,290).