The increasing prevalence of fungal resistance to conventional synthetic fungicides and growing environmental concerns have necessitated the development of sustainable alternatives for vineyard disease management. Metal-organic complexes (MOCs) represent a promising class of compounds that combine the antimicrobial properties of metal ions with the structural versatility of organic ligands, offering potential solutions for controlling major grapevine pathogens. This review evaluates the current state of research on MOCs as alternative fungicides in viticulture, examining their mechanisms of action, efficacy against common vineyard pathogens such as Botrytis cinerea, Plasmopara viticola, and Erysiphe necator, and their environmental impact compared to traditional fungicides. The synthesis, characterisation, and application methods of copper-, zinc-, and silver-based MOCs are discussed, along with their potential for targeted delivery and reduced ecological footprint. While preliminary studies demonstrate promising antifungal activity and lower phytotoxicity, challenges remain in terms of stability, cost-effectiveness, and regulatory approval. This comprehensive analysis highlights the potential of MOCs to revolutionise sustainable disease management in viticulture while identifying critical research gaps that must be addressed for successful commercial implementation.