A detailed review of wave energy resource assessment and the state-of-the-art of deployed wave energy converters (WECs) in real environmental conditions in the Mediterranean Sea have been analysed in this study. The installed power of the several deployed WECs in the Mediterranean Sea varies between 3–2500 kW. Ten project cases of deployed WECs in the basin are presented, with their analysis of the essential features. Five different types of WEC have already been tested under real environmental conditions in Italy, Greece, Israel and Gibraltar, with Italy being the Mediterranean country with the most deployed WECs. The main questions of the relevant studies were the ongoing trends, the examination of WECs in combination with other renewable sources, the utilising of WECs for desalination, and the prospects of wave energy in the Mediterranean islands and ports. This paper is the first comprehensive study that overviews the recent significant developments in the wave energy sector in the Mediterranean countries. The research concludes that the advances of the wave energy sector in the Mediterranean Sea are significant. However, in order to commercialise WECs and wave energy exploitation to become profitable, more development is necessary.