He first started coaching for the Oklahoma Sooners' basketball team. He has coached three different NBA teams; from 1973 through 1987, he coached the Phoenix Suns. This head coaching stint is considered one of the longest in the NBA. He also ended up coaching the Western Conference All-Star team in the 1981 NBA All-Star Game. The next year, he was hired by the Dallas Mavericks as head coach, a position he held for a bit over two years. In addition, he coached the New York Knicks for part of the 1990-1991 season. After he was fired from the Knicks, he coached the Notre Dame Fighting Irish from 1991 to 1999. He has also been an assistant head coach for the Suns during Scott Skiles' first season as head coach before officially retiring from coaching.
MacLeod had considerable success with Phoenix, but his teams did not win it all in the playoffs - they lost once in the NBA Finals, and twice at the Western Conference level. Due to the success that he had as their longest tenured head coach with 579 wins for the Suns, MacLeod was inducted into the Phoenix Suns Ring of Honor on April 18, 2012 against the Oklahoma City Thunder.