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Hospitals can be built in any county capital not just castles.
If you were to check your game you'd see there are theocratic rulers with hospitals in temples and maybe the odd one or two republics with hospitals in cities, also governors in admin realms.
I didn't want hospitals in every province because the buffs are too powerful, plus there are the vanilla hospices which can be built anywhere to provide epidemic resistance and piety/legitimacy buffs.
Your description states that Hospitals can be built in Cities and Temples, but in reality, this isn't possible. I checked the code, and Hospitals can only be built in the county capital, which effectively means they can only be built in Castles. Is this issue in need of a fix? The stress reduction function of Hospitals is very useful.
Sorry I have no idea, I don't use the mod, you'd have to ask the mod author.
No, MBR and COW are not compatible.