The Pagai Island Macaque is listed in Appendix II of the Convention on International Trade in Endangered Species (CITES), an international agreement between governments whose goal is to ensure that international trade in specimens of wild animals and plants does not threaten their survival.

As previously mentioned, this species does not occur in any protected areas. However, they do occur in areas that have been suggested for protection, such as the Betumonga Research Area, and the Sinakak Islet area. To complicate species preservation further, there is no viable captive population—meaning the preservation of the wild populations is absolutely vital for this species to survive. Supporting sustainable logging companies, conservation education, and alternative economic options for local people to avoid selling their land are just a few of the suggestions in a 2006 action plan. The IUCN suggests area and habitat protection, site and species management, legislation, conservation education, and trade management as being among the most pressing. Additionally, there is more research needed for this species to better protect and preserve them. 

Historically, primates on the Mentawai Islands have been loved and celebrated. Locals believed they were an intermediary to communicate with ancestors. Hunting, however, also has deep historical roots in the area. Now with subsidies and incentives, many people are moving out of the forest and into the cities, selling their land. People who once would have acted as protectors of the natural environment are being forced to move because of the logging and crop business. There are non-profits in the area that are currently working on a teacher-training curriculum, in which teachers are empowered to educate local communities about primates. The first teacher training happened in 2020 and it was attended by a dozen teachers, as well as elders in the community. Grassroots activism such as this is critical in preserving species.