Pilkington studied at Edinburgh College of Art (1985–91) and the Royal College of Art (1995–97). In 2014 she was elected a Royal Academician and was awarded the Sunny Dupree Family Award for her work Reclining Doll. In 2016 she became Professor of Sculpture and in 2020 she was elected Keeper at the Royal Academy Schools.
Selected solo exhibitions include: Weird Horses, Karsten Schubert London (2023); Estin Thalassa, Karsten Schubert London (2022); Working from Home, Pallant House Gallery, Chichester (2018–19); Dorich House Museum studio residency, London (2018); Doll for Petra, Ditchling Museum of Art and Craft (2017); The Life Rooms, Brighton Festival 2017; Life Room: Anatomy of a Doll, Royal Academy Schools Life Room, London (2017) and The Value of the Paw, V&A Museum of Childhood, London (2012)
Her work is held in the collections of Pallant House Gallery, Chichester; DESTE Foundation for Contemporary Art, Athens; Manchester Art Gallery, Manchester; The Hunterian, Glasgow; Omer Koc Collection and the Roberts Institute of Art.