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Simple Summary: Cats have been closely linked to humans for thousands of years. Nowadays, stray cats are frequently hosted in colonies, protected, and enrolled in programs of trap–neuter-–return to control population increase. Italian public veterinary services work in collaboration with voluntary colony caretakers and are responsible for neutering and monitoring the health of colony cats. This retrospective study, conducted by the Anatomical Pathology Unit of the Teaching Veterinary Hospital of Milan in collaboration with the public veterinary services, was undertaken because of the limited information available regarding causes of death of colony cats. The study reports on and statistically analyzes the causes of death of colony cats in the city of Milan as assessed by necropsy. Inflammatory processes including those consistent with the most relevant feline infectious diseases were most common in kittens and young cats. Trauma was more frequent in adult cats, while organ failure was the most common cause of death in aged cats. Considering the possible animal welfare issues deriving from colony cats, awareness of the most common causes of death and collaboration between university veterinary pathologists and public veterinary services represent an essential contribution to health monitoring of colony cats and can assist in the rapid detection of possible emerging animal welfare concerns. The presence of cats in urban environments has a long history. In Italy, stray cats are protected by national and regional laws, and programs of neutering and reintroduction to colonies are ongoing. Colony cats have been widely studied from a behavioral perspective, while surveys regarding their causes of death are limited, although they may provide relevant information related to public health and cat welfare. This retrospective study provides pathological descriptions and statistical analyses of the causes of death of 186 cats from 100 colonies in the city of Milan. Inflammatory processes represent the primary cause of death (37.7%) and include common feline infectious diseases such as feline panleukopenia (67.5%), particularly in kittens, and feline infectious peritonitis (32.5%), most common in adult cats. Trauma was found to be a common cause of death of young/adult cats (14%) with a generally good body condition, while severe parasitosis was less represented (2.6%). The death of old cats was statistically associated with organ failure (24.7%), particularly renal failure, and tumors (11.8%). Knowledge of the most common causes of death of colony cats could make an important contribution to the health monitoring of these cats and sanitary control of their habitats and provide information on possible related emerging animal welfare concerns. [ABSTRACT FROM AUTHOR]