During the lunar ninth month of every year, the Kusu Island pilgrimage attracts thousands of devotees who visit and worship at the Tua Pek Kong Temple.

At the top of the rugged hillock on Kusu Island stood a large shrine, the Keramat Kusu that consisted of three keramats (or sacred shrines of Malay holy figures) to commemorate a pious man (Syed Abdul Rahman), his mother (Nenek Ghalib) and his sister (Puteri Fatimah), all of whom once lived in the 19th century.

Built in 1923 by a wealthy businessman, the temple houses two main Chinese Deities, Da Bo Gong and Guān Yīn ("观音", or Goddess of Mercy).

The former is highly regarded as having the power to confer prosperity, cure diseases, calm the sea and avert danger, while Guan Yin is known as the "Bestower of Sons".

A stand-alone open-air hawker centre is located in the middle of the island but it is only open and running during certain periods of the year, such as during festivals or pilgrimages to the keramats or the temple.