The patch contains a delta-compressed executable and any new data that that executable might need. The Xbox 360's executable loader checks for the patch (via the game's title id), and, if found, loads the old executable into memory, then modifies it in-memory with the delta-compressed version. (The process of making a delta-compressed executable can take upwards of an hour, but the resulting executable size is well worth it).
Microsoft doesn't supply any tools to patch data. Any updated data will also be in the patch, but it will be up to the executable to look for it in an "update" area and apply it appropriately.
As mentioned, the patch needs to be stored somewhere- it can be either on the hard disc or on a memory card. If on the memory card, it will be put into the 8MB system-reserved area (patches are encouraged to be <4MB, so that 2 patches can be stored on a memory card; this can be exceeded with permission from Microsoft).
All patches must be cumulative- if you update a title to version 1.1, when you come out with version 1.2 it must contain all the changes from 1.1.