The role of grain size and crystallographic orientation on the biocompatibility of commercially pure titanium was investigated. Samples, with significant differences in crystallographic texture and average grain size (from 0.4 to 40 µm) were produced by equal channel angular pressing (ECAP) and post deformation annealing. X-ray diffraction and electron back scattered diffraction (EBSD) were used to evaluate differences in texture and microstructural characteristics. The titanium oxide film present on the surface of the samples was analyzed to determine the oxidation state of titanium and the chemical bonds between oxygen and titanium using X-ray photoelectron spectroscopy (XPS). Biocompatibility experiments were conducted using MC3T3 preosteoblast cells. Cell attachment was found to be texture-sensitive, where the number of attached cells was higher on the samples with higher number of (0002) planes exposed to the surface, regardless of the grain size. A relationship was also found between the titanium oxide species formed on the surface and the crystallographic texture underneath. The surface texture consisting of more densely packed basal planes promote the formation of Ti-OH on the surface, which in turn, enhances the cell-substrate interactions. These surface characteristics are deemed responsible for the observed difference in cell attachment behaviour of surfaces with different textures. Finally, it is inferred that texture, rather than the grain size, plays the major role in controlling the surface biocompatibility of biomedical devices fabricated from pure metallic titanium. © 2013 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 102A: 3631–3638, 2014.