Refugia can facilitate the persistence of species under long-term environmental change, but it is not clear if Pleistocene refugia will remain functional as anthropogenic climate change progresses. Dieback in populations restricted to refugia therefore raises concerns about their long-term persistence. Using repeat field surveys, we investigate dieback in an isolated population of Eucalyptus macrorhyncha during two droughts and discuss prospects for its continued persistence in a Pleistocene refugium. We first confirm that the Clare Valley in South Australia has constituted a long-term refugium for the species, with the population being genetically highly distinct from other conspecific populations. However, the population lost >40 % of individuals and biomass through the droughts, with mortality being just below 20 % after the Millennium Drought (2000–2009) and almost 25 % after the Big Dry (2017–2019). The best predictors of mortality differed after each drought. While north-facing aspect of a sampling location was significant positive predictor after both droughts, biomass density and slope were significant negative predictors only after the Millennium Drought, and distance to the north-west corner of the population, which intercepts hot, dry winds, was a significant positive predictor after the Big Dry only. This suggests that more marginal sites with low biomass and sites located on flat plateaus were more vulnerable initially, but that heat-stress was an important driver of dieback during the Big Dry. Therefore, the causative drivers of dieback may change during population decline. Regeneration occurred predominantly on southern and eastern aspects, which would receive the least solar radiation. While this refugial population is experiencing severe decline, some gullies with lower solar radiation appear to support relatively healthy, regenerating stands of red stringybark, providing hope for persistence in small pockets. Monitoring and managing these pockets during future droughts will be essential to ensure the persistence of this isolated and genetically unique population.