I have tesseract.exe working from the command line, I'm just not sure where it needs to be for perl.

It may well be ok where it is. The Makefile.PL is probably trying to run /usr/local/bin/tesseract or some such crap. The README that ships with the source warns of the package's deficiencies : "This package runs on Unix/Linux type OS".

What happens if you just do the bodgey installation by hand as I suggested in my last post ? (There may be reasons I'm unaware of that this will *not* work, but it's not hard to test.)
Alternatively, you have to dig into the source distro, work out why it can't find tesseract.exe, and make appropriate amendments to the source. Unfortunately, as soon as I see an 'inc' folder in a source distro, it makes me want to puke - so I can't really help much.

Cheers,
Rob
UPDATE: Often, the stuff that's in 'inc' proves to be unnecessary, and my first attempts at fixing problems that it raises are usually just to try and bypass it. So, I would first try removing the first 3 lines of the Makefile.PL and then re-run 'perl Makefile.PL'. (I expect that the EXE_FILES assignment in the Makefile.PL may need to be changed, too.)