The reservoir is a supplementary source of municipal water for Fort Collins, Greeley and other communities in the region, as well as for irrigation in the lower South Platte River basin.

Prior to construction, the majority of the town moved to a location that today surrounds Horsetooth's South Bay, but a few building foundations, including that of the old school house, are now under water.

Larimer County has provided recreation management at Horsetooth, which is surrounded by 1,900 acres of public lands,[4] and three other C-BT reservoirs since they opened in the early 1950s.

Since the late 1960s, the sport of bouldering has become an established climbing pastime at the reservoir as the hard Dakota sandstone provides many challenging problems for both American and foreign athletes.

[5] Road cycling around Horsetooth has also become popular as has hiking and mountain biking, particularly along the Foothills Trail that traverses the reservoir's eastern edge.

Other ridge lines surrounding the reservoir have become the site of residential development in recent decades, with structures ranging from get-away-cabins to luxury homes.