The downside is that there are a zillion implementations of everything you can imagine w/r/t a square grid, whereas implementations on a triangular grid of hexagonal pixels are fewer and further between, often some crappy matlab code written by a grad student, so you’d maybe need to reimplement, optimize, debug, etc. a whole pile of tools, or even invent some new algorithms for doing stuff that hasn’t been tried on such a grid before.
There have been lots of papers written about the topic, and at least one book. http://www.springer.com/us/book/9781852339142
* * *
It’s similar to the advantages you get from tri-axial fabric: it’s better but requires custom machinery, so in practice is only used for bullet-proof stuff, space suits, and art projects. Hexagonal pixels end up getting used in medical imaging, astronomical imaging, and the like, where pixels are individually expensive.
http://www.redblobgames.com/grids/hexagons/
It's written with game design in mind, but many of the techniques are useful just the same.
I'd guess that the need for error diffusion and half-toning might wane in the future. (Not sure about that, but that's what I'd guess.) Are there other benefits you get with hex images?