Coatings prepared by laser cladding technology possess excellent properties such as wear resistance, corrosion resistance, and resistance to fatigue wear, along with the advantage of achieving metallurgical bonding between the coating and the substrate. This study aims to realize the cost-effective and efficient repair of localized railway wheel damage using laser additive technology, employing three different types of alloy powders: Fe-based, Co-based, and 316L stainless steel. Localized repairs were carried out on wheel surfaces, and the rolling contact fatigue performance of the three coatings was comparatively analyzed. ER9 wheel steel was machined into small-scale wheels with a diameter of 60 mm, and notches were introduced on the surface to simulate localized damage. Using a TF-YF6000 laser system, Fe-based, Co-based, and 316L stainless steel coatings were deposited on the substrate surface under the following parameters: laser power of 2600 W, spot diameter of 3 mm, scanning speed of 0.6 m/min, and an overlap ratio of 50%. Rolling-sliding friction tests were subsequently conducted on the LGPS-30C wheel–rail contact simulation test bench. The microstructural morphology, phase composition, and nanohardness of the coatings were analyzed using a scanning electron microscope (SEM), X-ray diffractometer (XRD), optical microscope (OM), and nanoindenter, respectively. The results indicated that the coating surfaces were dense and exhibited good metallurgical bonding. The Fe-based, Co-based, and 316L stainless steel coatings primarily consisted of dendritic and eutectic microstructures, and their hardness was significantly enhanced compared to the base wheel material. Macro- and microscopic analysis of the wear morphology revealed critical differences in performance among the three coatings: the Co-based alloy coating exhibited a notably smooth and flat wear surface without any signs of crack initiation, demonstrating the best wear resistance; in contrast, the 316L stainless steel alloy coating showed significant flaking and more severe wear; while the Fe-based alloy coating displayed a relatively flat surface, it developed deeper cracks and extensive crack propagation at the substrate–coating interface, indicating a potential risk of coating fracture and detachment. The surface of the Fe-based coating exhibited fine scratches and ploughing marks, with an abrasive wear mechanism. The Co-based coating surface showed evidence of material accumulation, indicating an adhesive wear mechanism. The 316L stainless steel surface displayed pronounced spalling, with its wear mechanism primarily characterized as fatigue wear.