Anthropogenic warming of stream temperature and the presence of exotic diseases such as whirling disease are both contemporary threats to coldwater salmonids across western North America. We examined stream temperature reduction over a 15-year prerestoration and postrestoration period and the severity of Myxobolus cerebralisinfection (agent of whirling disease) over a 7-year prerestoration and postrestoration period in Kleinschmidt Creek, a fully reconstructed spring creek in the Blackfoot River basin of western Montana. Stream restoration increased channel length by 36% and reduced the wetted surface area by 69% by narrowing and renaturalizing the channel. Following channel restoration, average maximum daily summer stream temperatures decreased from 15.7°C to 12.5°C, average daily temperature decreased from 11.2°C to 10.0°C, and the range of daily temperatures narrowed by 3.3°C. Despite large changes in channel morphology and reductions in summer stream temperature, the prevalence and severity of M. cerebralis infection for hatchery Rainbow Trout Oncorhynchus mykiss remained high (98–100% test fish with grade > 3 infection) versus minimal for hatchery Brown Trout Salmo trutta (2% of test fish with grade-1 infection). This study shows channel renaturalization can reduce summer stream temperatures in small low-elevation, groundwater-dominated streams in the Blackfoot basin to levels more suitable to native trout. However, because of continuous high infections associated with groundwater-dominated systems, the restoration of Kleinschmidt Creek favors brown trout Salmo trutta given their innate resistance to the parasite and the higher relative susceptibility of other salmonids.