Xanthine and its derivatives are considered an important class of N-heterocyclic purine compounds that have gained significant importance in medicinal chemistry. N-heterocyclic carbene (NHC) and N-coordinated metal complexes of xanthine and its derivatives have revealed a range of new possibilities for their use as therapeutic agents in addition to their established catalytic behavior. The metal complexes of xanthine and its derivatives have been designed and synthesized for the exploration of their potential therapeutic applications. These metal complexes based on the xanthine scaffold exhibited various potential medicinal applications including anticancer, antibacterial, and antileishmanial activity. The metal complexes of xanthine and its derivatives shall pave the way for the rational design and development of new therapeutic agents. In the present comprehensive review, we highlighted the recent advancements in the synthesis and medicinal applications of metal complexes based on N-heterocyclic carbene (NHC) derived from xanthine scaffolds.