The use of ZnO for the functionalization of textile substrates is growing rapidly, since it can provide unique multifunctional properties, such as photocatalytic self-cleaning, antimicrobial activity, UV protection, flame retardancy, thermal insulation and moisture management, hydrophobicity, and electrical conductivity. This paper aims to review the recent progress in the fabrication of ZnO-functionalized textiles, with an emphasis on understanding the specificity and mechanisms of ZnO action that impart individual properties to the textile fibers. The most common synthesis and application processes of ZnO to textile substrates are summarized. The influence of ZnO concentration, particle size and shape on ZnO functionality is presented. The importance of doping and coupling procedures to enhance ZnO performance is highlighted. The need to use binding and seeding agents to increase the durability of ZnO coatings is expressed. In addition to functional properties, the cytotoxicity of ZnO coatings is also discussed. Future directions in the use of ZnO for textile functionalization are identified as well.