With the increasingly urgent requirements of environmental friendliness, resource conservation and industrial sustainability, Industry 5.0 aims to lead the industry towards efficiency, intelligence and sustainable development through technological innovation and industrial upgrading. The sustainability of a product largely depends on the design stage, and enterprises have identified sustainable design as a key development strategy. For complex customised products (CCPs) with high technology integration and multidisciplinary knowledge fusion, sustainable design is required to go beyond traditional material and shape considerations and focus more on the entire development process. However, the numerous concepts related to the connotation of sustainable design and the lack of systematisms and integrity make it difficult to effectively integrate and respond to the uniqueness and complexity of the development process of CCPs. Therefore, this review attempts to summarise the existing concepts of sustainable design from environment, economy, and society, and comprehensively explore the connotation of comprehensive sustainable design (CSD) in Industry 5.0. Subsequently, integrating systems engineering (SE), this review discusses the applicability and differences between traditional and advanced methodologies in comprehensive sustainability and analyses process sustainability-related factors. Finally, a CSD reference framework is developed, providing a direction for enterprises to achieve sustainable transformation.