The Little Ice Age in South Africa, from around AD 1300 to 1800, and medieval warming, from before 1000 to around 1300, are shown to be distinctive features of the regional climate of the last millennium. The proxy climate record has been constituted from oxygen and carbon isotope and colour density data obtained from a well-dated stalagmite derived from Cold Air Cave in the Makapansgat Valley. The climate of the interior of South Africa was around 1°C cooler in the Little Ice Age and may have been over 3°C higher than at present during the extremes of the medieval warm period. It was variable throughout the millennium, but considerably more so during the warming of the eleventh to thirteenth centuries. Extreme events in the record show distinct teleconnections with similar events in other parts of the world, in both the northern and southern hemispheres. The lowest temperature events recorded during the Little Ice Age in South Africa are coeval with the Maunder and Sporer Minima in solar irradiance. The medieval warming is shown to have coincided with the cosmogenic 10Be and 14C isotopic maxima recorded in tree rings elsewhere in the world during the Medieval Maximum in solar radiation.