Urban design quality is often assessed through the presence or appearance of physical features, although residents experience design through what spatial form enables in everyday life. This study develops and tests a lived urban performance model explaining how perceived urban design quality is associated with perceived design–satisfaction attribution in Makkah, a hot-climate pilgrimage city where permanent residents coexist with recurring high-volume visitor pressure. Survey data from 340 valid respondents across Makkah neighborhoods were analyzed in R using hierarchical partial least squares structural equation modeling (PLS-SEM). Urban design quality and walkability and access were specified as reflective–formative higher-order composites and estimated through a disjoint two-stage approach. Inference was based on 5000 bootstrap samples, supplemented by measurement-sensitivity, original-specification, common-method, and repeated cross-validation checks. Urban design quality was strongly associated with walkability and access (β = 0.756), public-space quality (β = 0.358), and perceived local economic vitality (β = 0.522). Its direct association with perceived design–satisfaction attribution was not significant (β = 0.058), whereas its total indirect association was substantial (β = 0.464, 95% CI [0.340, 0.596]). Perceived local economic vitality showed the strongest direct association with perceived design–satisfaction attribution (β = 0.373), followed by public-space quality (β = 0.167). Open-ended responses identified shade and heat protection as the most salient local need. The findings show that urban design quality is associated with perceived design–satisfaction attribution primarily through its statistical associations with thermally viable access, usable public space, and continuity of everyday services. The study contributes a context-sensitive and reproducible framework for evaluating lived urban performance and social sustainability in hot-climate cities exposed to tourism, pilgrimage, or recurrent large-event pressures.