Disclaimer: Numbers in this proposal are purposefully left out. Numbers for Twitch's damage can all be tweaked in different areas to add or remove power where it is necessary. This post is about solidifying a theme and enhancing the playstyle of a Marksman/Assassin.
First, I'm going to get into a bit of philosophy of assassins and marksmen here so bear with me.
I believe that an assassin is healthiest when nearly the entirety of his or her pure (100-0) assassination potential is tied to their ultimate. Zed can skirmish a bit, poke at you, and go in for a combo but he will not be able to 100-0 you without using his highly telegraphed ultimate. This is important for two reasons: one is because Ultimate abilities are only accessibly at level 6, 11, and 16 and the other is that ultimates have much longer cooldowns in comparison to regular abilities. The combination of these two factors make ultimate abilities more easily trackable by the opposing team for when they need to pay attention to not only to an assassin's power spikes, but also to their periods of vulnerability.
A Marksman's ult can be well defining of who they are but they are built to function by consistently damage opponents primarily through their auto attacks. Marksmen playstyles can and do vary by champion but their ultimates are not there solely to burst down a high priority target.
Because Twitch is a Marksman first and an assassin second I believe his ult should add a noticeable amount of power to his kit but not be an ability he absolutely needs to deal all his damage. Basically, Twitch's ult needs more of an overall emphasis on team fighting than catching out a single target while simultaneously remaining an appropriate aspect towads his success when he decides to sneak up on an unsuspecting mid laner.
I also believe that Twitch's kit lacks a necessary amount of depth and involvement with his poison which leaves many players feeling like he isn't as much of the "Plague Rat" as he could be. To change this I would suggest altering two things; his W and his Ult.
Twitch's W is, right now, both the least interesting and the least necessary part of his kit. His W basically only shortens the amount of total auto attacks you need before you can achieve maximum damage from his E. The ability does also slow targets in the field it hits but because this is the only increased benefit you get after further leveling his W you naturally do not want to level up this skill until all your other abilities have been fully upgraded. I'd propose a change to keep the slow on his W while removing the added 2 poison stacks in exchange for increasing the total poison damage Twitch inflicts upon those who have been hit by his Venom Cask. This should add some decision making to the skill by making players ask themselves the question of: "do I need the slow to keep this tank off of me or can I hold on to it and use it to help quickly take out a more valuable target?"
Small side note- because this ability is a skill shot, it should feel pretty rewarding to land and much less so if missed.
Twitch's current ultimate gives bonus range as well as some extra attack damage to make his autos hurt just that much more (they also pierce targets but as shown in my last post I suggested moving this aspect to his passive). One of the problems I see in this ability is that it achieves very little in adding to a theme of a poisonous "Plague Rat" marksman.
Now, we could debate all day as to whether or not the range increase on Twitch's ultimate is actually crucial to Twitch's gameplay and/or if it adds meaningful depth to his character or not so I am going to leave out mention of a range increase in my proposed R ability and leave the questions of Twitch's natural auto attack range vs his temporary auto attack range to someone else.
My proposed Ultimate change for this character is still up in the air a bit but I want, again, to emphasize the poison qualities that twitch has. Before I proposed that, during his ultimate, Twitch will infect opponents with a much stronger version of Deadly Venom. I have not decided yet upon its exact interactions but I still do like the idea where enemy champions killed while infected with this special venom transfer the status effect to nearby units in some way. With this new ultimate you still get a noticeable increase of power through effective use of the ability while preserving a good amount of assassination potential as well as a niche Twitch has had: his killing of an entire team with a well-timed ultimate, auto attacks, passive maintenance, and the burst from his E. You don't want to group up around a Twitch who has his passive stacks ready and especially not when he is killing one of your teammates with his extra deadly venom; that will certainly lead to the destruction of your team.