The Pitcairn Islands, located in the central South Pacific, contain near-pristine marine ecosystems which support unique fish assemblages, together with both endemic and threatened species. Pitcairn itself is the only inhabited island in the group and, before this study, the environmental impact of local fisheries was unclear, with little data to inform conservation and management. In 2014–2015 coastal fish populations were assessed using a mixed methods approach: a newly introduced system of fishers’ catch monitoring and Baited Remote Underwater Video Systems (BRUVS). Thirty-nine BRUVS deployments recorded 88 species in total, with small-bodied herbivores (e.g., Kyphosus pacificus) and mesopredators (e.g., Xanthichthys mento) dominating a “bottom heavy” assemblage. Several large pelagic predators were recorded, but reef-associated predators were rare with only one shark observed. Pitcairn’s top predator assemblage was relatively impoverished compared to global “pristine” sites, including other islands within the Pitcairn group. Top predator scarcity may be explained by local artisanal fisheries, which have historically targeted sharks and other large reef carnivores, and these taxa may not have recovered despite subsequent declines in fishing pressure. The dominant small-bodied species may have proliferated as a result of diminished top predator populations. Subsequent to BRUVS sampling, a local fisheries officer post was created to collate catch data from coastal fishers. Regular returns were obtained from over half of the active fishers (representing approximately 80% of catches), with K. pacificus also dominating catches and the small grouper Epinephelus fasciatus frequently targeted. Thirty fish species were represented in the recorded catch over a 12 month period. Results were shared with the local community, providing a basis for the cooperative design of a Fisheries Management Plan. This plan ensured traditional fisheries could continue in a sustainable manner within Coastal Conservation Zones around each of the four Pitcairn Islands, established within the large, no-take Marine Protected Area designated in 2016, covering the entire Pitcairn Exclusive Economic Zone. Monitoring of Pitcairn’s artisanal fisheries should be continued beyond this one-off study in order to inform adjustment of the Fisheries Management Plan, as the ongoing island fishery may still have consequences for long-term sustainability, particularly for pelagic species caught in coastal waters which remain a significant data gap.