Despite increased concerns about dairy cattle welfare, there is a paucity of knowledge regarding their welfare and the attitudes of farmers and veterinarians in the Western Balkan region. This is the first on-farm study to address dairy cattle welfare and the attitudes of farmers and veterinarians towards animal welfare in Kosovo. Thirty tie-stall dairy farms across seven Kosovo regions were assessed twice with an interval of 10 to 12 months. During the first visit, the Welfare Quality® assessment protocol was applied, whilst the second visit focused on clinical animal-based indicators and interviews with the farmers regarding intervention thresholds for a number of welfare indicators. Additionally, such thresholds were obtained from 15 veterinarians via an online questionnaire. The main areas of concern that were highlighted relate to comfort around resting (soiling of animals, restriction of lying down movements) and injuries, including lameness. Farmers and veterinarians agreed on the intervention thresholds for the majority of the indicators (eg animals with dirty udders, animals with lesions/swellings) but differences were found for important health and welfare issues (eg farmers suggesting a higher threshold for lameness compared to veterinarians). Compared to the on-farm prevalences, both farmers and veterinarians suggested lower intervention levels for welfare issues indicating an awareness of problems. In conclusion, investments into close co-operation between farmers, veterinarians and other advisors regarding awareness-building and inducing changes in daily management routines are considered necessary to improve dairy cow welfare.