Coastal cities are at the frontlines of climate change impacts, resulting in an urgent need for substantial adaptation. To understand whether, and to what extent, cities are on track to prepare for climate risks, this paper systematically assesses the academic literature to evaluate evidence on climate change adaptation in 199 coastal cities worldwide. Results show that adaptation in coastal cities is rather slow, of narrow scope and not transformative. Adaptation measures are predominantly designed based on past and current—rather than future—patterns in hazards, exposure and vulnerability. City governments, particularly in high-income countries, are more likely to implement institutional and infrastructural responses, whereas coastal cities in lower-middle-income countries often rely on households to implement behavioral adaptation. There is comparatively little published knowledge on coastal urban adaptation in low- and middle-income countries, and regarding particular adaptation types such as ecosystem-based adaptation. These insights make an important contribution for tracking adaptation progress globally and help to identify entry points for improving adaptation of coastal cities in the future.