The song features a 5/4 timing, and is one of the few songs he wrote to be played in standard tuning. The string arrangement was composed by Harry Robinson and Robert Kirby. Though Drake never revealed the identity of the 'Betty' character in the lyrics, Trevor Dann speculated that she may have been drawn from Betty Fox, a character in Wordsworth's "The Idiot Boy", a poem Drake had studied while attending Cambridge.

American jazz pianist Brad Mehldau has been known to be a great admirer of Drake's music, and has recorded River Man on numerous albums, such as Live in Tokyo, usually remaining very faithful to the dark, autumnal sound that defines Drake's recording.