I'm resisting KiCad and sticking with Eagle as long as I can : P It's what I learned on.
But to your question, I do use it for the top control drill template. I do a lot of custom designs, but I've also made a few that match the PedalPCB Tayda drill patterns (again, only the top). For back side drilling (jacks and DC) I do all of the measurements in 3D, but I'm going to standardize that so I can use the Eagle enclosure footprints for drill templating.
I've borrowed quite a bit from Madbean's Eagle Library, but I've also added in some custom bits. Here's a couple set up for 3 and 4 knob configurations (PPCB patterns)
View attachment 69332
And one for my 1590B3 adventuresL:
View attachment 69334
My other custom ones are sort of arbitrary, and followed a very inconsistent pattern.
Anyhow, that's how I do. Still using Eagle (and in mils, no less)
edit: the footswitch drill position varies, depending on the board size. I like to keep it away from the extreme end, so that diagram is adjustable.
Edit 2: up till about now, I've used Illustrator to do everything short of the schematic and board layout. It's nice to have the art, hardware, and drill patterns all in one file on respective layers. I still will use illustrator for the art, but for boards that aren't my own, I'll use their drill patterns (obvs). Still, all in one place in convenient.