EXPERT RESPONSE
It is highly recommended that you do not host SQL Server and Exchange Server on the same server. Both Exchange Server and SQL Server will want to take all the RAM, as well as both being very disk intensive (Exchange Server is a JET database so it's performing basic database operations under the hood).
Reducing the number of SQL Server instances will definitely help performance. There isn't really any reason that all these applications couldn't use a single database instance. The upside to this will be that they can all share a single pool of RAM. The downside is you can't specify how much RAM each one uses.
If I was the administrator on this box, I'd pull all the SQL Server databases into a single instance of SQL Server, and if possible move that instance to another server. With everything that this server is doing it's very possible that the two disk drives are killing the system. Without having performance monitor data handy, I can't dig into the system specifically, but those would be two excellent places to start.
Because Exchange Server is on there, you'll want to limit your SQL Server databases to about 768 MB of RAM total. This way Exchange Server can have some RAM, as well as the operating system.
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