I had to eventually talk about Hokage Madara, at some point, especially since I have some thoughts about it.
I know some people like to use this scenario as a fix-it, a way for Madara to be less miserable, at least, but I am one of the folks who think Madara would be even more miserable as Hokage.
Frankly, the only upside would be that he would have more authority to counter Tobirama, but even then... he was already generally disliked, so to be put in a position of power would only make him the target of more hate from the people because things aren't going exactly as planned.
Hashirama probably didn't deal with much backlash, because he's charismatic as hell and everyone loves him, but Madara is feared, all of Hashirama's less than ideal decisions and the way the Village turned into a military state would slide well if Madara was leading (though I think Madara would try to steer away from this as much as possible, and would be more active to protect his ideals)
Maybe, Madara was more suited as a Hokage than Hashirama, and maybe the Village would have been better under his guidance. But Madara doesn't like being a leader, he doesn't like having people in his back. He would be miserable, and it's a tragic ending either way for him.
Either he doesn't find about the tablet and dies overworking himself, or he finds it and go even more crazy than in the canon timeline.
In both cases, it's not good (sorry Hashirama)
In my opinion, the best fix it for a situation in which Izuna is still dead would be to have Hashirama nearly killed. How would that happen, I hear you ask in my head, he's the God of Shinobi!
Well, it would be complicated, but let's say he does something stupid (as he often does) and trusts someone he shouldn't, and maybe gets poisoned or trapped and barely escapes. It'd be a whole big thing, a lot of people would die in this singular assassination trial, but it could happen, and if Madara manages to find out and save Hashirama... well that would drive him insane but he would have a goal once again.
Madara's mental state would hit a new low, sure, but he is at his best when fiercely protective of someone, and he clearly dreads Hashirama's death, so a wake up call (not coming from Hashirama's threat to himself) would, yes, break something in him, but it would give more meaning to the Village, I think...
That's my thoughts, at least.
Bonus: forgot the Hokage had this drape thing with the hat, so I added it here + the first sketch
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