Well, the interface IS pretty shitty. The only way I could play the game without being irritated by the magic/special ability/weapon-selection interface was to make most things use hotkeys (attack, pickpocket, hide in shadows, dialogue... basically everything).
After I did that the game was great and really fast-paced for me, which was good, since I could get to the good bits (i.e. ripping out your own spleen and combining it with a glowing green sphere and an AK-47 to make the TRANSMOGRIFICATION SWORD RAY GUN).
Anyways, where was I? Not sure? Me neither. Moving on...
640x480 wasn't really that big of a problem for me, since having a large field of view wasn't terribly necessary due to the lack of challenging combat, BUT if you look at PST areas in Infinity Explorer at a higher resolution, they look really amazing.