Cities worldwide are increasingly attempting to address social challenges by applying innovative approaches, such as human-centered design (HCD). Generalized knowledge on how HCD is applied in urban contexts and why urban challenges are addressed through empathy toward citizens are limited. This study presents a systematic literature review aimed at mapping existing HCD practices in urban contexts, exploring the key drivers and challenges associated with their application. The review reveals four key rationales for applying HCD in cities (the why): improving public administration, enhancing citizen participation, driving social change, and prioritizing user-centeredness. Additionally, the review provides a deeper understanding of the impact and scalability of these design practices by identifying four main types of design deliverables typically employed in urban HCD initiatives (the how): product design, design proposals, design frameworks, and process redesigns. These problem-solving processes in cities are illustrated through the Double Diamond model. Although a promising approach, cities have struggled to institutionalize HCD in their everyday work routines. The ideal-typical HCD model challenges dominant public administration practices but is often likely to conflict with universality and traditional policy approaches.