Thin-film nano-architecting is a promising approach that controls the properties of nanoscale surfaces to increase their interdisciplinary applications in a variety of fields. In this context, zinc oxide (ZnO)-based various nano-architectures (0-3D) such as quantum dots, nanorods/nanotubes, nanothin films, tetrapods, nanoflowers, hollow structures, etc. have been extensively researched by the scientific community in the past decade. Owing to its unique surface charge transport properties, optoelectronic properties and reported biomedical applications, ZnO has been considered as one of the most important futuristic bio-nanomaterials. This review is focused on the design/synthesis and engineering of 0-3D nano-architecture ZnO-based thin films and coatings with tunable characteristics for multifunctional biomedical applications. Although ZnO has been extensively researched, ZnO thin films composed of 0-3D nanoarchitectures with promising thin film device bio-nanotechnology applications have rarely been reviewed. The current review focuses on important details about the technologies used to make ZnO-based thin films, as well as the customization of properties related to bioactivities, characterization, and device fabrication for modern biomedical uses that are relevant. It features biosensing, tissue engineering/wound healing, antibacterial, antiviral, and anticancer activity, as well as biomedical diagnosis and therapy with an emphasis on a better understanding of the mechanisms of action. Eventually, key issues, experimental parameters and factors, open challenges, etc. in thin film device fabrications and applications, and future prospects will be discussed, followed by a summary and conclusion.