We present MSCoT, a multi-scale, coarse-to-fine model for test-time human motion synthesis and control. Unlike recent approaches that rely on multiple iterative denoising/token-prediction steps, or modules tailored for specific control signals, MSCoT discretizes motion into a multi-scale hierarchical representation and predicts the entire token sequence at each temporal scale in a coarse-to-fine fashion. Building on this coarse-to-fine paradigm, we propose an efficient multi-scale token guidance strategy that overcomes the challenge of discrete sampling and steers the token distribution towards the control goals, allowing for fast and flexible control. To address the limitations of a discrete codebook, a lightweight token refiner further adds continuous residuals to the discrete token embeddings and allows differentiable test-time refinement optimization to ensure precise alignment with the control objectives. MSCoT is able to produce quality motions, consistent with the control constraints, while offering substantially faster sampling than diffusion-based approaches. Experiments on popular benchmarks demonstrate state-of-the-art controllable text-to-motion generation performance of MSCoT over existing baselines, with better motion quality (48% FID improvement), higher control accuracy (-61% avg error), and $10 \times$ faster inference speed on HumanML3D.