The river's two main headwaters come from Steeple Grange, below Bolehill, and the fields below the National Stone Centre, Ravenstor.

The Ecclesbourne flows mostly underground through the area of the Sough, but momentarily appears above ground in several places, near Ecclesbourne Cottages at the bottom of Sough Lane, in a shallow ditch next to the railway (now piped) and also near the bottom of Fanny Shaws Park, again near the main railway track.

Part of the main headwaters of the Ecclesbourne flowed past the rectangular Sough Reservoir, which transported water up to the quarries around Wirksworth.

Below Fanny Shaws Park and skatepark the Ecclesbourne leaves the Sough area and goes underground and reappears in the Hannages further down the railway tracks, where it powered the mills at the bottom of Wirksworth.

Species of conservation interest found along the Ecclesbourne include white-clawed crayfish, kingfisher, otter and water vole.

The river is one of 25 river catchments chosen by Defra for a Pilot Catchment Project, with the aim of encouraging co-operation between various agencies and interested parties to improve water quality, as part of the UK's commitment to the EU Water Framework Directive.