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The competition is usually stronger in the USA (.com) arena than in Canada (.ca). I have a little company site (with little work done in the way of SEO) that ranks #3 in both .ca and .com for "wheelchair trays". You may want to adjust your settings on Google WebMasterTools to ensure your site is set to United States rather than Canada. As David Kauzlaric has mentioned, you will definitely benefit from having more links from US based sites - I'd focus on that as a first step.

I'd leave them in, however I'd want to make sure you don't have more than 10 or 12. I'd also add some misspellings for important keywords as Bing 'used to' use the keywords meta tag data for misspellings. Having said this, I agree with Richard Getz's response in that it should be the very last thing to deal with. Both Google and Bing have clearly said they don't use the keyword meta tag data for search anymore... however, it wouldn't hurt to leave them in on the premise they might be using them for some other signal (you never know). The one downside is that you might be making it easier for competitors to know about the keywords you're focusing on.