The only "downside" that I see at the moment is that it doesn't recognize apps that are installed in another way. Given that I've installed most of the software that I need already it makes Cask much less useful to me. If there was some way to let Cask scan your system and know that I've already installed google-chrome and adium that would be cool.
Quite a few of the apps I use (iTerm2, ST3, Chrome, Adium, etc.) update themselves periodically. I wonder how Cask deals with that?