The town FPS could be improved by having fewer things in them

Well, places like Markarth would likely benefit from a more complicated renderer since it has so many opportunities to notice something's completely behind a structure and "cull" it based on that, just skipping its rendering. If you look upwards from the near entrance the FPS drops hard despite only the wall of the large structure and a few doorways being visible, so clearly there isn't a lot of culling going on right now. There's plenty of techniques for doing that, but many of them involve extra work for the level designer, or complicate the renderer a lot without being usable for arbitrary scenes.
Dunno about the nice view from the top of Whiterun, doesn't seem like you could occlusion-cull that very much. Just too many (different) things visible at once.
These kinds of issues are probably why the Imperial City was split up into so many pieces in Oblivion.
I recall the Unreal Engine's editor having several specialized views for determining just how much extra gets processed and drawn + how many lights are landing on each object, wonder if the Skyrim toolset has anything like that.