<p>Borate bioactive glasses (BBGs) have attracted considerable interest in recent years as advanced biomaterials for tissue engineering and regenerative medicine. This review offers an extensive analysis of the evolution of bioactive glasses, tracing the transition from conventional silicate-based systems to the development of BBGs, which exhibit superior degradation rates, enhanced ion release profiles, and improved biological performance. The synthesis of BBGs via melt-quenching and sol–gel methods is discussed, highlighting how processing routes influence porosity, surface area, and bioactivity. The structural, mechanical, and chemical characteristics of BBGs are discussed in detail, highlighting the influence of borate networks on bioactivity, dissolution behaviour, and mechanical integrity. Furthermore, the strategic incorporation of therapeutic metal ions into BBGs is explored, emphasizing their potential to modulate cellular responses, enhance antibacterial activity, and accelerate tissue regeneration. Finally, the diverse biomedical applications of BBGs are presented, including their roles in wound healing, scaffolds, bone grafts, drug delivery, nerve regeneration, osteomyelitis treatment, and broader clinical applications. This review provides a comprehensive overview of the recent advancements, challenges, and future prospects of BBGs, reinforcing their potential as next-generation materials in the field of regenerative healthcare.</p>