Attention is increasingly being paid to the influence of hinterland cities on port competitiveness, but in-depth research is lacking on the formation conditions and mechanism of hinterland cities’ influence on port competitiveness. Based on the technology–organization–environment (TOE) framework and the characteristics of Chinese government organizational behavior, in this study, we used fuzzy-set qualitative comparative analysis (fsQCA) to conduct a condition configuration analysis of 21 coastal ports and their hinterland cities in China. The findings showed the following: (1) The technology, organization, and environment conditions of hinterland cities cannot provide the necessary conditions for high or low port competitiveness alone: different combinations of these conditions have produced three high and four low port competitiveness configurations. (2) The three configurations of high port competitiveness are the organization–environment, economy–balance, and finance–balance types. Adequate government financial supply, high tertiary industry proportion, good economic development, and market openness are the core conditions required for achieving high port competitiveness. (3) The four configurations of low port competitiveness are finance–facilities–environment, capability–finance–environment, technology–finance–economy, and capability–industry–economy restrictions. Here, low-level innovation capability, inadequate government financial supply, and low tertiary industry proportion are the core conditions leading to low port competitiveness. We revealed the concurrent synergistic effect of the three conditions of technology, organization, and environment in hinterland cities and demonstrated the causal complexity and asymmetry of the impact of hinterland cities on port competitiveness. Our conclusions provide empirical evidence that will aid hinterland cities in formulating differentiated port competitiveness promotion policies according to their own conditions and endowments.