He is one of three changes named on Thursday by interim coach Scott Johnson for the last of three Tests for the Scots on tour in South Africa.
Zimbabwe-born David Denton comes in on the flank for injured Ryan Wilson while Alastair Kellock will earn a 55th cap at lock in place of Jim Hamilton, who has returned to Britain for the impending birth of his second child.
Heathcote, from English club Bath, won only a second cap against Samoa in Durban on June 8 but suffered concussion in one of many brutal hits that left the Scots team battered and bruised after a 27-17 loss.
He is back in place of the more experienced Ruaridh Jackson, who has not overcome a shoulder injury suffered last Saturday when Scotland bravely went down 30-17 to South Africa in Nelspruit.
Three news caps from last weekend's match, fullback Peter Murchie, winger Tommy Seymour and lock Tim Swinson, all kept their places.
"I said that this tour would be about broadening our base and that we'd find out about whether certain players were ready to play international rugby," Johnson added at the team announcement.
"That has happened and we'll take a lot from that but we also want to end the tournament on a high against an Italian team that we know well and that we respect greatly."
Greig Laidlaw keeps the captaincy after Kelly Brown was forced to return home for medical treatment after the Samoa match.
Team: 15-Peter Murchie, 14-Tommy Seymour, 13-Alex Dunbar, 12-Matt Scott, 11-Sean Lamont, 10-Tom Heathcote, 9-Greig Laidlaw, 8-Johnnie Beattie, 7-Dave Denton, 6-Alasdair Strokosch, 5-Alastair Kellock, 4-Tim Swinson, 3-Euan Murray, 2-Scott Lawson, 1-Alasdair Dickinson
Replacements: 16-Fraser Brown, 17-Moray Low, 18-Jon Welsh, 19-Grant Gilchrist, 20-Rob Harley, 21-Henry Pyrgos, 22-Duncan Taylor, 23-Tim Visser.
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- Alastair Kellock