Ethnobotanical studies have highlighted the need to address temporal dynamics of local knowledge in response to socio-economic changes. The southwestern Balkans are a hotspot of folk botanical knowledge and represent a unique region to study such dynamics. The present study focused on changes in ethnomedicinal knowledge in the rural mountains of Prespa National Park, Albania. The resident ethnic Macedonian minority was fairly isolated under communism (1946–1991), with a long tradition of wild medicinal plant collection. We identified 80 adults and 20 young community members through snowball sampling based on knowledgeability of medicinal plants. In-depth open and semi-structured interviews, free-listing, and participant observation elicited ethnomedicinal knowledge on past and present uses. We recorded 82 botanical taxa belonging to 39 families. Cultural importance analyses showed that Sideritis raeseri Boiss. & Heldr. was by far the culturally most salient species. Informants perceived a steep increase in home consumption of medicinal plants compared to the communist period, despite increased globalization and market liberalization. Trade had significantly decreased but remained an important fallback option in times of economic uncertainty. We observed the phenomenon of knowledge hybridization through access to “modern” knowledge and homogenization through political influences, pointing towards a both resilient and dynamic body of knowledge.