(This guide was written as of OpenMW 0.49)

1 - Use OpenMW, and configure any OpenMW built-in tweaks as desired, and enable controller support/configure your controller buttons if desired. (In the rare case your controller isn't natively supported properly by OpenMW's built-in SDL feature, you can generate your own map config for it using tools found online and add it to gamecontrollerdb.txt in OpenMW's files)

2 - For controller users, adjust controller sensitivity/speed by going to the settings.cfg file and adding and setting "gamepad cursor speed", which controls the speed of the cursor within GUI mode when using the joystick/controller (has no effect on the camera rotation speed). For example, add the following line under [Input]: "gamepad cursor speed = 0.2". You can also experiment with setting smooth movement either enabled or disabled.

3 - So text appears nice and clear: Use new fonts by disabling the old ones in openmw.cfg (to do so, comment/delete the following lines there "fallback=Fonts_Font_0,magic_cards_regular" & "fallback=Fonts_Font_2,daedric_font"). Also grow window sizes by setting them in settings.cfg, for example in settings.cfg file under [GUI] set the following: "scaling factor = 1.55" and "font size = 18". Also enable different color for already-asked dialogue options (in the OpenMW launcher, under Settings/Advanced -> Interface -> "Change dialogue topic color"). Instant improvement for dialogue & books.

4 - Use the Voices of Vvardenfell mod and its OpenMW patch. (https://www.nexusmods.com/morrowind/mods/54137) Morrowind is now voice acted!

5 - Use the UI Modes plugin so that characters mouths open/close when speaking (https://modding-openmw.gitlab.io/ui-modes/). Voice acting now improved!

6 - Add a take-all key/controller binding, such as by using this mod (https://www.nexusmods.com/morrowind/mods/56083).

7 - Add any additional mods or tweaks whether they're for improvements or additions in graphics, mechanics, voices, companions, features, etc. as desired. There are already countless sites about mods, many making the game more awesome or beautiful, so I think I won't go further into those here when there is plenty of information elsewhere. But at least after this guide the game is now much more playable and functional for modern audiences and on controller!

(Some minor tweaks you may want to enable from the OpenMW launcher, but there are many others too: "Show melee info", "show projectile damage", "show effect duration", "show owned objects", etc.; can also enable some third-person improvements that make it function more like later Elder Scrolls games by going to Scripts->OpenMW Camera in-game and enabling "Move 360".)