diff --git a/.chloggen/healthcheck-v2-ext.yaml b/.chloggen/healthcheck-v2-ext.yaml
new file mode 100644
index 000000000000..a504cad4e971
--- /dev/null
+++ b/.chloggen/healthcheck-v2-ext.yaml
@@ -0,0 +1,27 @@
+# Use this changelog template to create an entry for release notes.
+
+# One of 'breaking', 'deprecation', 'new_component', 'enhancement', 'bug_fix'
+change_type: 'enhancement'
+
+# The name of the component, or a single word describing the area of concern, (e.g. filelogreceiver)
+component: extension/healthcheckv2
+
+# A brief description of the change.  Surround your text with quotes ("") if it needs to start with a backtick (`).
+note: Add extension/subcomponent management logic.
+
+# Mandatory: One or more tracking issues related to the change. You can use the PR number here if no issue exists.
+issues: [26661]
+
+# (Optional) One or more lines of additional information to render under the primary note.
+# These lines will be padded with 2 spaces and then inserted directly into the document.
+# Use pipe (|) for multiline entries.
+subtext:
+
+# If your change doesn't affect end users or the exported elements of any package,
+# you should instead start your pull request title with [chore] or use the "Skip Changelog" label.
+# Optional: The change log or logs in which this entry should be included.
+# e.g. '[user]' or '[user, api]'
+# Include 'user' if the change is relevant to end users.
+# Include 'api' if there is a change to a library API.
+# Default: '[user]'
+change_logs: []
diff --git a/extension/healthcheckv2extension/extension.go b/extension/healthcheckv2extension/extension.go
index 033a481f00dd..6cecded478c4 100644
--- a/extension/healthcheckv2extension/extension.go
+++ b/extension/healthcheckv2extension/extension.go
@@ -7,36 +7,198 @@ import (
 	"context"
 
 	"go.opentelemetry.io/collector/component"
+	"go.opentelemetry.io/collector/confmap"
 	"go.opentelemetry.io/collector/extension"
+	"go.uber.org/multierr"
 	"go.uber.org/zap"
+
+	"github.com/open-telemetry/opentelemetry-collector-contrib/extension/healthcheckv2extension/internal/grpc"
+	"github.com/open-telemetry/opentelemetry-collector-contrib/extension/healthcheckv2extension/internal/http"
+	"github.com/open-telemetry/opentelemetry-collector-contrib/extension/healthcheckv2extension/internal/status"
 )
 
+type eventSourcePair struct {
+	source *component.InstanceID
+	event  *component.StatusEvent
+}
+
 type healthCheckExtension struct {
-	config    Config
-	telemetry component.TelemetrySettings
+	config        Config
+	telemetry     component.TelemetrySettings
+	aggregator    *status.Aggregator
+	subcomponents []component.Component
+	eventCh       chan *eventSourcePair
+	readyCh       chan struct{}
 }
 
 var _ component.Component = (*healthCheckExtension)(nil)
+var _ extension.ConfigWatcher = (*healthCheckExtension)(nil)
+var _ extension.PipelineWatcher = (*healthCheckExtension)(nil)
 
 func newExtension(
-	_ context.Context,
+	ctx context.Context,
 	config Config,
 	set extension.Settings,
 ) *healthCheckExtension {
-	return &healthCheckExtension{
-		config:    config,
-		telemetry: set.TelemetrySettings,
+	var comps []component.Component
+
+	errPriority := status.PriorityPermanent
+	if config.ComponentHealthConfig != nil &&
+		config.ComponentHealthConfig.IncludeRecoverable &&
+		!config.ComponentHealthConfig.IncludePermanent {
+		errPriority = status.PriorityRecoverable
+	}
+
+	aggregator := status.NewAggregator(errPriority)
+
+	if config.UseV2 && config.GRPCConfig != nil {
+		grpcServer := grpc.NewServer(
+			config.GRPCConfig,
+			config.ComponentHealthConfig,
+			set.TelemetrySettings,
+			aggregator,
+		)
+		comps = append(comps, grpcServer)
+	}
+
+	if !config.UseV2 || config.UseV2 && config.HTTPConfig != nil {
+		httpServer := http.NewServer(
+			config.HTTPConfig,
+			config.LegacyConfig,
+			config.ComponentHealthConfig,
+			set.TelemetrySettings,
+			aggregator,
+		)
+		comps = append(comps, httpServer)
 	}
+
+	hc := &healthCheckExtension{
+		config:        config,
+		subcomponents: comps,
+		telemetry:     set.TelemetrySettings,
+		aggregator:    aggregator,
+		eventCh:       make(chan *eventSourcePair),
+		readyCh:       make(chan struct{}),
+	}
+
+	// Start processing events in the background so that our status watcher doesn't
+	// block others before the extension starts.
+	go hc.eventLoop(ctx)
+
+	return hc
 }
 
 // Start implements the component.Component interface.
-func (hc *healthCheckExtension) Start(context.Context, component.Host) error {
+func (hc *healthCheckExtension) Start(ctx context.Context, host component.Host) error {
 	hc.telemetry.Logger.Debug("Starting health check extension V2", zap.Any("config", hc.config))
 
+	for _, comp := range hc.subcomponents {
+		if err := comp.Start(ctx, host); err != nil {
+			return err
+		}
+	}
+
 	return nil
 }
 
 // Shutdown implements the component.Component interface.
-func (hc *healthCheckExtension) Shutdown(context.Context) error {
+func (hc *healthCheckExtension) Shutdown(ctx context.Context) error {
+	// Preemptively send the stopped event, so it can be exported before shutdown
+	hc.telemetry.ReportStatus(component.NewStatusEvent(component.StatusStopped))
+
+	close(hc.eventCh)
+	hc.aggregator.Close()
+
+	var err error
+	for _, comp := range hc.subcomponents {
+		err = multierr.Append(err, comp.Shutdown(ctx))
+	}
+
+	return err
+}
+
+// ComponentStatusChanged implements the extension.StatusWatcher interface.
+func (hc *healthCheckExtension) ComponentStatusChanged(
+	source *component.InstanceID,
+	event *component.StatusEvent,
+) {
+	// There can be late arriving events after shutdown. We need to close
+	// the event channel so that this function doesn't block and we release all
+	// goroutines, but attempting to write to a closed channel will panic; log
+	// and recover.
+	defer func() {
+		if r := recover(); r != nil {
+			hc.telemetry.Logger.Info(
+				"discarding event received after shutdown",
+				zap.Any("source", source),
+				zap.Any("event", event),
+			)
+		}
+	}()
+	hc.eventCh <- &eventSourcePair{source: source, event: event}
+}
+
+// NotifyConfig implements the extension.ConfigWatcher interface.
+func (hc *healthCheckExtension) NotifyConfig(ctx context.Context, conf *confmap.Conf) error {
+	var err error
+	for _, comp := range hc.subcomponents {
+		if cw, ok := comp.(extension.ConfigWatcher); ok {
+			err = multierr.Append(err, cw.NotifyConfig(ctx, conf))
+		}
+	}
+	return err
+}
+
+// Ready implements the extension.PipelineWatcher interface.
+func (hc *healthCheckExtension) Ready() error {
+	close(hc.readyCh)
 	return nil
 }
+
+// NotReady implements the extension.PipelineWatcher interface.
+func (hc *healthCheckExtension) NotReady() error {
+	return nil
+}
+
+func (hc *healthCheckExtension) eventLoop(ctx context.Context) {
+	// Record events with component.StatusStarting, but queue other events until
+	// PipelineWatcher.Ready is called. This prevents aggregate statuses from
+	// flapping between StatusStarting and StatusOK as components are started
+	// individually by the service.
+	var eventQueue []*eventSourcePair
+
+	for loop := true; loop; {
+		select {
+		case esp, ok := <-hc.eventCh:
+			if !ok {
+				return
+			}
+			if esp.event.Status() != component.StatusStarting {
+				eventQueue = append(eventQueue, esp)
+				continue
+			}
+			hc.aggregator.RecordStatus(esp.source, esp.event)
+		case <-hc.readyCh:
+			for _, esp := range eventQueue {
+				hc.aggregator.RecordStatus(esp.source, esp.event)
+			}
+			eventQueue = nil
+			loop = false
+		case <-ctx.Done():
+			return
+		}
+	}
+
+	// After PipelineWatcher.Ready, record statuses as they are received.
+	for {
+		select {
+		case esp, ok := <-hc.eventCh:
+			if !ok {
+				return
+			}
+			hc.aggregator.RecordStatus(esp.source, esp.event)
+		case <-ctx.Done():
+			return
+		}
+	}
+}
diff --git a/extension/healthcheckv2extension/extension_test.go b/extension/healthcheckv2extension/extension_test.go
new file mode 100644
index 000000000000..b988172afcd9
--- /dev/null
+++ b/extension/healthcheckv2extension/extension_test.go
@@ -0,0 +1,135 @@
+// Copyright The OpenTelemetry Authors
+// SPDX-License-Identifier: Apache-2.0
+
+package healthcheckv2extension
+
+import (
+	"context"
+	"fmt"
+	"io"
+	"net/http"
+	"os"
+	"path/filepath"
+	"testing"
+	"time"
+
+	"github.com/stretchr/testify/assert"
+	"github.com/stretchr/testify/require"
+	"go.opentelemetry.io/collector/component"
+	"go.opentelemetry.io/collector/component/componenttest"
+	"go.opentelemetry.io/collector/confmap/confmaptest"
+	"go.opentelemetry.io/collector/extension/extensiontest"
+
+	"github.com/open-telemetry/opentelemetry-collector-contrib/extension/healthcheckv2extension/internal/status"
+	"github.com/open-telemetry/opentelemetry-collector-contrib/extension/healthcheckv2extension/internal/testhelpers"
+	"github.com/open-telemetry/opentelemetry-collector-contrib/internal/common/testutil"
+)
+
+func TestComponentStatus(t *testing.T) {
+	cfg := createDefaultConfig().(*Config)
+	cfg.HTTPConfig.Endpoint = testutil.GetAvailableLocalAddress(t)
+	cfg.GRPCConfig.NetAddr.Endpoint = testutil.GetAvailableLocalAddress(t)
+	cfg.UseV2 = true
+	ext := newExtension(context.Background(), *cfg, extensiontest.NewNopSettings())
+
+	// Status before Start will be StatusNone
+	st, ok := ext.aggregator.AggregateStatus(status.ScopeAll, status.Concise)
+	require.True(t, ok)
+	assert.Equal(t, st.Status(), component.StatusNone)
+
+	require.NoError(t, ext.Start(context.Background(), componenttest.NewNopHost()))
+
+	traces := testhelpers.NewPipelineMetadata("traces")
+
+	// StatusStarting will be sent immediately.
+	for _, id := range traces.InstanceIDs() {
+		ext.ComponentStatusChanged(id, component.NewStatusEvent(component.StatusStarting))
+	}
+
+	// StatusOK will be queued until the PipelineWatcher Ready method is called.
+	for _, id := range traces.InstanceIDs() {
+		ext.ComponentStatusChanged(id, component.NewStatusEvent(component.StatusOK))
+	}
+
+	// Note the use of assert.Eventually here and throughout this test is because
+	// status events are processed asynchronously in the background.
+	assert.Eventually(t, func() bool {
+		st, ok = ext.aggregator.AggregateStatus(status.ScopeAll, status.Concise)
+		require.True(t, ok)
+		return st.Status() == component.StatusStarting
+	}, time.Second, 10*time.Millisecond)
+
+	require.NoError(t, ext.Ready())
+
+	assert.Eventually(t, func() bool {
+		st, ok = ext.aggregator.AggregateStatus(status.ScopeAll, status.Concise)
+		require.True(t, ok)
+		return st.Status() == component.StatusOK
+	}, time.Second, 10*time.Millisecond)
+
+	// StatusStopping will be sent immediately.
+	for _, id := range traces.InstanceIDs() {
+		ext.ComponentStatusChanged(id, component.NewStatusEvent(component.StatusStopping))
+	}
+
+	assert.Eventually(t, func() bool {
+		st, ok = ext.aggregator.AggregateStatus(status.ScopeAll, status.Concise)
+		require.True(t, ok)
+		return st.Status() == component.StatusStopping
+	}, time.Second, 10*time.Millisecond)
+
+	require.NoError(t, ext.NotReady())
+	require.NoError(t, ext.Shutdown(context.Background()))
+
+	// Events sent after shutdown will be discarded
+	for _, id := range traces.InstanceIDs() {
+		ext.ComponentStatusChanged(id, component.NewStatusEvent(component.StatusStopped))
+	}
+
+	st, ok = ext.aggregator.AggregateStatus(status.ScopeAll, status.Concise)
+	require.True(t, ok)
+	assert.Equal(t, component.StatusStopping, st.Status())
+}
+
+func TestNotifyConfig(t *testing.T) {
+	confMap, err := confmaptest.LoadConf(
+		filepath.Join("internal", "http", "testdata", "config.yaml"),
+	)
+	require.NoError(t, err)
+	confJSON, err := os.ReadFile(
+		filepath.Clean(filepath.Join("internal", "http", "testdata", "config.json")),
+	)
+	require.NoError(t, err)
+
+	endpoint := testutil.GetAvailableLocalAddress(t)
+
+	cfg := createDefaultConfig().(*Config)
+	cfg.UseV2 = true
+	cfg.HTTPConfig.Endpoint = endpoint
+	cfg.HTTPConfig.Config.Enabled = true
+	cfg.HTTPConfig.Config.Path = "/config"
+
+	ext := newExtension(context.Background(), *cfg, extensiontest.NewNopSettings())
+
+	require.NoError(t, ext.Start(context.Background(), componenttest.NewNopHost()))
+	t.Cleanup(func() { require.NoError(t, ext.Shutdown(context.Background())) })
+
+	client := &http.Client{}
+	url := fmt.Sprintf("http://%s/config", endpoint)
+
+	var resp *http.Response
+
+	resp, err = client.Get(url)
+	require.NoError(t, err)
+	assert.Equal(t, http.StatusServiceUnavailable, resp.StatusCode)
+
+	require.NoError(t, ext.NotifyConfig(context.Background(), confMap))
+
+	resp, err = client.Get(url)
+	require.NoError(t, err)
+	assert.Equal(t, http.StatusOK, resp.StatusCode)
+
+	body, err := io.ReadAll(resp.Body)
+	require.NoError(t, err)
+	assert.Equal(t, confJSON, body)
+}
diff --git a/extension/healthcheckv2extension/go.mod b/extension/healthcheckv2extension/go.mod
index 7065e6499325..4a89b3c1c53b 100644
--- a/extension/healthcheckv2extension/go.mod
+++ b/extension/healthcheckv2extension/go.mod
@@ -15,6 +15,7 @@ require (
 	go.opentelemetry.io/otel/metric v1.28.0
 	go.opentelemetry.io/otel/trace v1.28.0
 	go.uber.org/goleak v1.3.0
+	go.uber.org/multierr v1.11.0
 	go.uber.org/zap v1.27.0
 	google.golang.org/grpc v1.65.0
 )
@@ -62,7 +63,6 @@ require (
 	go.opentelemetry.io/otel/exporters/prometheus v0.50.0 // indirect
 	go.opentelemetry.io/otel/sdk v1.28.0 // indirect
 	go.opentelemetry.io/otel/sdk/metric v1.28.0 // indirect
-	go.uber.org/multierr v1.11.0 // indirect
 	golang.org/x/net v0.27.0 // indirect
 	golang.org/x/sys v0.22.0 // indirect
 	golang.org/x/text v0.16.0 // indirect