Just like its predecessors, Silent Hill: Downpour is a survival horror game set in the town and the surroundings of Silent Hill. This entry features a convicted felon called Murphy Pendleton as the protagonist. He has been incarcerated for many years after stealing a police cruiser. After a riot at the Ryall State Corrections Facility where he is locked up, he is transferred with some other inmates to the Wayside Maximum Security Prison. During the transport that brings them near Silent Hill, the road suddenly ends into a void and the driver crashes the bus through barriers, down the hill. When Murphy regains consciousness, he manages to escape from his captors and looks for a way out through the surroundings. Through the story Murphy meets people from the area, fellow escaped prisoners and members of prison security. When he encounters strange entities and occurrences however, the line between dreams and reality starts to blur.

In the tradition of the series, Downpour combines exploring abandoned surroundings, talking to characters, and solving puzzles, set against a slow, psychological horror theme. Different from the previous game Silent Hill: Shattered Memories is the return of combat. Murphy often has to fight off monsters using a variety of weapons, but he can carry only one melee and one ranged weapon. These also deteriorate over time. Murphy can also fight creatures when unarmed, but can not block their attacks when doing so. There is no visible health system, but when Murphy is in bad shape his clothes become bloody and he starts to limp. At key moments of the game the player has to make a number of decisions that define the moral compass. This eventually leads to different endings. Next to the main storyline there are different sidequests that are optional for completion.

Entirely new to the series is the introduction of a weather system. There is a full day and night cycle and rain often warns the player of danger that is approaching. It is possible to hide until the weather becomes better again. Most of the game is set in the nature and surroundings of Silent Hill, with mountains, woods, and streams, but also locations in the city as well as the series' famous transfer to the industrial hell of the Otherworld when the town's evil influence distorts the environment.