Tune my VM Windows Server

I have a windows VM server running in the Azure cloud. It is the 2BS with 2 VCPUs and 4 gig of RAM. It is running SQL Express and a few websites under IIS. Unfortunately it runs like a dog and always appears to have close to 100% CPU usage. I have no idea why the cpu is so maxed out some of the time.

If you have the experience and can help let me know. You will need a rating of no less than 4.9 for me to reply.

Thanks