Despite shuffling his squad, each of the Glasgow contingent involved in last Sunday's clash with Ireland is retained in the matchday 23 by Townsend, as Scotland go in search of a tenth consecutive win over the Azzurri.
Fagerson's return sees the tight-head win his 37th cap for his country, having missed the meeting with Ireland due to suspension.
Younger brother Matt continues at number eight after his impressive form in the championship to date, having made more carries than any other Scottish player in their three matches so far in 2021.
Huw Jones is rewarded for his barnstorming cameo from the bench against the Irish by being promoted to the starting XV, lining up at outside centre for his first start in a Scotland shirt since last February's Calcutta Cup fixture at BT Murrayfield.
An all-Glasgow midfield partnership sees Sam Johnson line up in the number 12 shirt, having made his international debut against the Italians in 2019.
George Turner rotates to the bench, having previously started each of Scotland's opening three matches in the championship.
He's joined by Ali Price, who is the most experienced of Scotland's replacements with 40 caps to his name.
10 Stuart Hogg CAPTAIN (Exeter Chiefs)
9 Scott Steele (Harlequins)
1 Rory Sutherland (Edinburgh)
2 David Cherry (Edinburgh)
3 Zander Fagerson (Glasgow Warriors)
4 Sam Skinner (Exeter Chiefs)
5 Grant Gilchrist (Edinburgh)
6 Jamie Ritchie VICE CAPTAIN (Edinburgh)
7 Hamish Watson (Edinburgh)
8 Matt Fagerson (Glasgow Warriors)
16 George Turner (Glasgow Warriors)
17 Jamie Bhatti (Bath Rugby)
18 Simon Berghan (Edinburgh)
19 Alex Craig (Gloucester)
20 Nick Haining (Edinburgh)
21 Ali Price (Glasgow Warriors)
22 Jaco van de Walt (Edinburgh)
23 Chris Harris (Gloucester)