This review summarizes recent advances (2023–2025) in coumarin-based fluorescent probes, highlighting their structural modularity, tunable VIS–NIR photophysics, and broad applicability in detecting metal ions, biothiols, ROS/RNS, organelle-specific microenvironments, and amyloid-β aggregates. Particular emphasis is placed on multifunctional and organelle-targeted probes, as well as emerging NIR-emissive and theranostic systems enabling deep-tissue imaging and modulation of pathological processes. The perspectives section outlines current limitations and future directions toward clinically relevant coumarin-based imaging tools. A though the review focuses on literature published from 2023 onward, several earlier studies are cited selectively to clarify fluorescence mechanisms, illustrate reaction pathways, or provide essential photophysical benchmarks necessary for contextual understanding.