To meet climate targets, a global shift away from fossil fuels is essential. For sectors where electrification is impractical, it is crucial to find sustainable energy carriers. Renewable methanol is widely considered a promising fuel for powering heavy-duty applications like shipping, freight transport, agriculture, and industrial machines due to its various sustainable production methods. While current technological efforts focus mainly on dual-fuel engines in shipping, future progress hinges on single-fuel solutions using renewable methanol to achieve net-zero goals in the heavy-duty sector. This review examines the research status of technologies enabling methanol as the sole fuel for heavy-duty applications. Three main categories emerged from the literature: spark-ignition, compression-ignition, and pre-chamber systems. Each concept’s operational principles and characteristics regarding efficiency, stability, and emissions were analyzed. Spark-ignition concepts are a proven and cost-effective solution with high maturity. However, they face limitations due to knock issues, restricting power output with larger bore sizes. Compression-ignition concepts inherently do not suffer from end-gas autoignition, but encounter challenges related to ignitability due to the low cetane number of methanol. Nonetheless, various methods for achieving autoignition of methanol exist. To obtain stable combustion at all load points, a combination of techniques will be required. Pre-chamber technology, despite its lower maturity, holds promise for extending the knock limit and enhancing efficiency by acting as a distributed ignition source. Furthermore, mixing-controlled pre-chamber concepts show potential for eliminating knock and the associated size and power limitations. The review concludes by comparing each technology and identifying research gaps for future work.