Current advances in the fabrication of smart nanomaterials and nanostructured surfaces find wide usage in the biomedical field. In this context, nanosensors based on localized surface plasmon resonance exhibit unprecedented optical features that can be exploited to reduce the costs, analytic times, and need for expensive lab equipment. Moreover, they are promising for the design of nanoplatforms with multiple functionalities (e.g., multiplexed detection) with large integration within microelectronics and microfluidics. In this review, we summarize the most recent design strategies, fabrication approaches, and bio-applications of plasmonic nanoparticles (NPs) arranged in colloids, nanoarrays, and nanocomposites. After a brief introduction on the physical principles behind plasmonic nanostructures both as inherent optical detection and as nanoantennas for external signal amplification, we classify the proposed examples in colloid-based devices when plasmonic NPs operate in solution, nanoarrays when they are assembled or fabricated on rigid substrates, and nanocomposites when they are assembled within flexible/polymeric substrates. We highlight the main biomedical applications of the proposed devices and offer a general overview of the main strengths and limitations of the currently available plasmonic nanodevices.