Although I can't say this is in anyway consider great since it looks like something out of MSpaint, I have to admit the way it is drawn really help with the creepiness factor. It's simple yet still brings out how freaky those motherfucking clowns are. I like it...and I want to kill it.
Like I said all those years ago about another one, given the right circumstances, this could be overwhelmingly creepy. Like a crayon drawing left behind by whichever spook of the week happens to be starring in a horror movie/book/game.
I don't think that style is because of low quality, it's more about how it flow with creepyness of this art. More clear and "proper" style would ruin it. This dream-like, foggy "feel" and bizarre, bended lines cannot be replaced.
I remember when I first saw Clownpiece, I thought to myself that finally after all the fate-changing vampires, killer ghost, reality-gap warpers, nuclear hell monsters, that finally, we have a touhou that might actually be scary.