To identify factors associated with medium-term business recovery, this study analyzes large-scale survey data on businesses located in diverse urban contexts around the world. While most studies of business recovery focus on the short term, the factors influencing short-term recovery may differ from those important in the medium term. This study provides cross-country evidence four to five years after the COVID-19 outbreak, based on a survey of 3,454 firms across seven global regions, including major cities in Canada, the United States, the European Union, New Zealand, South Africa, Thailand, and Japan, with 35 % of firms located in downtown districts.</p> <p>Across 26 variables, including policy measures, business characteristics, and strategies, several consistent patterns emerge. Non-governmental mentoring and training show the strongest positive association with sales recovery, exceeding the effects of loans and subsidies, highlighting the importance of non-financial support. By contrast, smaller firms (1–19 employees) exhibit persistently lower recovery levels and rely more heavily on personal funds, indicating structural vulnerability. While some conventional comparisons align with prior expectations, substantial heterogeneity is observed across regions and sectors. In particular, regional context and sectoral composition significantly influence the effectiveness of adaptation and policy measures. These findings provide new cross-country and urban-level evidence on medium-term SME recovery and highlight the importance of tailored, region- and sector-specific policy design to strengthen business resilience against future systemic shocks.