In 1945, Rand was approached by King Features Syndicate about having a condensed, illustrated version of the novel published for syndication in newspapers. Rand agreed, provided that she could oversee the editing and approve the proposed illustrations of her characters, which were provided by Frank Godwin. The 30-part series began on December 24, 1945, and ran in over 35 newspapers.
In 1949, Warner Brothers released a film based on the book, starring Gary Cooper as Howard Roark, Patricia Neal as Dominique Francon, Raymond Massey as Gail Wynand, and Kent Smith as Peter Keating. The film was directed by King Vidor. The Fountainhead grossed $2.1 million, $400,000 less than its production budget. However, sales of the novel increased as a result of interest spurred by the film. In letters written at the time, the author's reaction to the film was positive, saying "The picture is more faithful to the novel than any other adaptation of a novel that Hollywood has ever produced" and "It was a real triumph." However, she displayed a more negative attitude towards it later, saying that she "disliked the movie from beginning to end", and complaining about its editing, acting and other elements. As a result of this film, Rand said that she would never sell any of her novels to a film company that did not allow her the right to pick the director and screenwriter as well as edit the film, as she did not want to encounter the same production problems that occurred on this film.
In June 2014, an adaptation for the stage (in Dutch) was presented at the Holland Festival, directed by Ivo van Hove, with Ramsey Nasr as Howard Roark. The production subsequently went on tour, appearing in Barcelona in early July 2014, and then at the Festival d'Avignon later that month.