If Tilshead were a town at all – which remains a question-mark – there is little to be said of it. Any significance it may have had, from an urban standpoint, would have been in the Late Saxon period and it must thereafter have remained stagnant or even declined. In consequence it makes few appearances in surviving medieval documents; furthermore, no archaeological investigation was undertaken there until 2006-07 (when the work did not produce anything pertinent to the issue of urbanity) , and the only known surviving medieval fabric is the church, which dates back to the early twelfth century.

Tilshead is in the central part of the county, on Salisbury Plain. Connecting to the River Wylye, the Till, now reduced to a stream, flowed strongly enough in the eleventh century to power mills and have a wide swath of meadow associated; the name of the watercourse derives from the estate, which is a corruption of 'Theodwulf's hide' (the name used in Domesday). Tilshead is also on the road between Market Lavington and the adjacent villages of Maddington and Shrewton, both marketless, continuing to Amesbury in the latter direction, and Devizes in the former. Elizabeth Crittall felt that "its existence can only be explained by the rapid extension of sheep farming in late Saxon times". [VCH Wiltshire, vol.4 (1959), p.1].

The Domesday entry for Tilshead has 66 burgesses associated with it and, like Great Bedwyn, was a part of the king's ancient demesne with the obligation of hosting him and his retinue for one night a year. On these grounds has arisen the suspicion it was a royal borough, whose role within the royal administration of Wessex involved collection and distribution of sheep and wool; topographical evidence from the site, along (it appears) with the mistaken belief that a borough charter exists, supported the possibility of urban status and led to Tilshead's inclusion in the Extensive Urban Survey of Wiltshire, whose report, however, is riddled with errors and self-contradictions, a reflection of the uncertainty that exists over Tilshead.

By the early twelfth century the large estate of Tilshead had been broken up into two manors which were in turn divided between two different hundreds (though combined in a single parish). Medieval reference are mostly to the manors and the lands granted out of them, without mentioning village or town; in the hundredal enquiries of 1274/75, it is again the manors of which we hear, and the advowson of the church is mentioned as still being in the hands of the king. Tilshead North was granted by Henry I to Holy Trinity Abbey, Caen, while Tilshead South was held by Romsey Abbey by 1206. Either of these could have been potential town-founders, but there is no evidence that suggests any such initiatives. We have no references to burgesses after 1086 and the low number of tax-payers in 1377 suggests Tilshead had failed to grow in population size, relative to other settlements, from its Domesday figure, which is unusually large.

The church is situated just north of a T-junction of a road from the north-east with the present High Street, a curving through-road that approaches from the south then swings westwards at the junction. The High Street widens out at the junction – which (together with the churchyard) seems to mark the dividing line between North and South Tilshead manors – to form a triangular open space there; this could be interpreted as a marketplace, despite the lack of licence or other evidence for a market – only the assumption it was a Domesday borough prompting its inclusion in the Gazetteer. The High Street is presumed to be the axial street of the borough component, and the widened stretch just west of the junction might be indicative of market activity. There is a back lane to north (still so named) and possibly another south of the western branch of the High Street; these might have marked the rear boundaries of properties. The present properties on either side of the High Street have the long and narrow appearance of burgage plots, yet may have originated rather as contiguous tofts, though this is not necessarily an obstacle to defining Tilshead as a small pre-Conquest town. It remains unknown, however, whether this layout is the result of organic growth or planning, and whether it dates to the time of the Late Saxon settlement or to a later period.

We rely on the slightest of documentary evidence and on topography to convince us Tilshead was urban, and even Jeremy Haslam, in his study of Anglo-Saxon towns in Wiltshire, did not venture to suggest a possible date for its origins as a town. In fact, more recently he changed his mind and concluded that the Domesday burgesses were probably residents in the burghal territory of Wilton, though appurtenant to Tilshead in terms of customary dues ["A probable late Saxon burh at Ilchester," 2009, p.10; https://jeremyhaslam.files.wordpress.com/2009/12/a-probable-late-saxon-burh-at-ilchester-1.pdf]. If Tilshead was indeed a Saxon market town, it may have retained its market function well into the Middle Ages, but probably would not have proved very competitive with other such towns that later emerged across the region.