As China shifts from expansion-oriented urbanization to stock-based renewal, cities need diagnostic tools that can identify built-environment deficiencies and translate them into spatially targeted renewal priorities. Building on China’s official urban physical examination system, this study develops a land-renewal-oriented diagnostic workflow across four spatial scales: housing, community, block, and urban area. The framework integrates top-down objective assessment of land, facilities, infrastructure, environment, and safety conditions with bottom-up resident satisfaction evaluation. It then converts composite health scores, problem concentration, and safety relevance into three renewal priority categories: Priority Level III (critical renewal), Priority Level II (general renewal), and Priority Level I (long-term optimization). Using Wu’an, a resource-dependent county-level city in Hebei Province, as a case study, the results show that Priority Level III problems are concentrated mainly at the housing scale, especially corridor safety hazards, while widespread pipeline aging and age-friendly retrofitting needs are classified as Priority Level II medium-term renewal issues. Community and block scales mainly show facility, governance, and functional mismatches. The contribution of this study is not the four-tier scale structure itself, which is derived from existing policy, but the operational translation of urban physical examination results into spatial diagnosis for land renewal, renewal priority classification, and action-plan formulation. The workflow offers a transferable methodological reference for county-level stock renewal, while local indicators, thresholds, and implementation pathways require contextual adaptation.