Increasing frequency of extreme weather events, driven by climate change, has resulted in an increasing demand for coastal structures to protect and stabilize shorelines. Concrete seawalls are a common category of coastal protection structures, designed with the primary objectives of absorbing wave action, preventing coastline erosion, and alleviating flooding. Much research has been carried out on improving the seawall performance. This work is a review of the current state-of-the-art in concrete seawalls focusing on design aspects including wave loading and innovative seawall designs, ecological considerations, and durability aspects. Wave loads on seawalls have received significant attention; however, their quantification remains a challenging task especially for novel designs. Drawing inspiration from natural shorelines, modification of surface complexity at a multitude of scales can improve the otherwise poor ecological performance of seawalls. The corrosion of the steel is a major durability concern, and the use of non-corrosive reinforcement can increase seawall durability towards corrosion. Examples of innovative seawall designs and systems which have the capability to outperform conventional seawalls are discussed. Advances in structural design, ecological engineering, and infrastructure materials science will drive the development of multi-functional seawalls which are sustainable, durable, and resilient.