Metals and their alloys have been widely used in all aspects of science, engineering and medicine. Metals in biomedical devices are used due to their inertness and structural functions. They are generally preferred over polymers or ceramics and are especially desirable in applications where the implants are subjected to static, dynamic or cyclic loads that require a combination of strength and ductility. In biomedicine, the choice of a specific biomaterial is governed by many factors that include biocompatibility, corrosion resistance, controlled degradability, modulus of elasticity, fatigue strength and many other application specific criterions. Nanotechnology is driving newer demands and requirements for better performance of existing materials and presents an opportunity for surface modification of metals in response to demands on the surface of metals for their biomedical applications. Self-assembled monolayers (SAMs) are nanosized coatings that present a flexible method of carrying out surface modification of biomaterials to tailor its surface properties for specific end applications. These nanocoatings can serve primary functions such as surface coverage, etch protection and anti-corrosion along with a host of other secondary chemical functions such as drug delivery and biocompatibility. We present a brief introduction to surface modification of biomaterials and their alloys followed by a detailed description of organic nanocoatings based on self-assembled monolayers and their biomedical applications including patterning techniques and biological applications of patterned SAMs.