Different strategies have been proposed to optimize injection mold cooling to reduce cycle time and improve efficiency. While recent research has focused on the design of additively manufactured conformal cooling inserts, the impact of mold maintenance conditions on cooling performance has received limited attention, particularly regarding the formation of limescale. This work presents a numerical modeling approach to quantify the combined effects of thermal resistance and hydraulic restriction caused by limescale accumulation in high-aspect-ratio cooling channels used in slender mold cores. An integrated thermal-fluid analysis is employed to evaluate coolant flow behavior and heat-transfer performance and to assess their coupled influence on cooling efficiency and part dimensional stability. The results show that, in slender cooling channels, even thin limescale deposits can significantly reduce cooling performance, with hydraulic restriction emerging as the dominant mechanism under the investigated conditions due to the reduced effective flow area. Design strategies that reduce effective frictional length and mitigate limescale deposition reduced part temperature by approximately 10 °C and shortened cooling time by about 17%. Further optimization of coolant flow conditions yielded an additional 65% reduction in cooling time. These findings highlight the importance of integrating cooling design with preventive maintenance to achieve robust injection molding performance.