Pakistan is the world’s 4th largest producer of cotton. Cultivation along the Indus River extends across nearly 3 million hectares and serves as the backbone of the economy. Despite this importance, information on the cotton sector in Pakistan, in particular with regard to cotton oils, is scanty and not available from a single source. This review seeks to remedy that gap. Though cultivated mainly for fiber, its kernel seed oil is also used as an edible vegetable oil and accounts for a large share of the local oil industry; per capita consumption of edible oils is nearly 14 kg, which is much higher than consumption in countries at similar levels of economic development. Pakistan fulfills 17.7% of its demand for edible oils through cottonseed oil. Total demand for this purpose in 2029–30 is estimated at 5.36 million tons of which local production will be 1.98 million tons. Genetically modified (Bt) cotton was introduced in Pakistan in 2010 to control three deleterious lepidopterous insects; it now accounts for more than 85% of the cotton cultivated. There is good scope for organic cotton production in Pakistan, especially in non-traditional cotton growing areas where there is less insect pressure. High temperature and water scarcity associated with climate change are a major concern, since current cultivation takes place in areas that already experience extremely high temperatures.