Puzzled about a few things

Is it supposed to mean that he realised the that she is indeed grown up

That's how I've always read that scene. For once he actually heeded what she said, albeit passive-aggressively because he behaves like a martyr when he says he's only ever done all this for her sake (he's denying some of his own "stage mother" selfish motives here). It's manipulative of him to make her feel that she's the unreasonable one here but he's aware enough to see that he does need to change his approach with her.

Was he genuinely only interested in her career at that point or was he in denial about his feelings?

I see it as simply part of his transition in his feelings towards her. The film is deliberately ambiguous about when his feelings changed; all we can be sure of is that he was completely indifferent when she was 14, only interested in her musically 14-17, and the audience (but not Nicholas) is supposed to be clear about his feelings for F by the time of him wistfully watching the Rachmaninov concert (the night she goes off to find Peter and rebuffs N- that's the cross-over moment in their story arcs: he's shown to be vulnerable at last, and she's now finding her strength).

Denying her the chance to be with Peter could just be N not wanting her to throw away her career by getting married at 17 or it could be unrecognised jealousy; personally, I think it's musical ambition mixed with his default domineering nature at this point- but it's impossible to tell for sure because we know that the writers originally had her ending up with Peter. How much of the script did they revise once they made that change? It muddies the character motivations because we can't see him as an ogre anymore since we're supposed to root for their relationship and therefore go looking for early positive signs that would have been interpreted differently had she ended up with Peter.

he extends his hand to her and says that "there's nothing to be frightened of anymore" . What's the meaning of that? He was willing to let her go with the painter, despite his obvious attachment to her? Was he about to tell her he indeed loves her but got interrupted by the painter coming in? Also, did the painter understand that Nicholas loved her then?

I saw it as his acknowledged meaning is that she doesn't need to be frightened that her hands are too damaged to play the piano ever again. Also, since she's just admitted she finds him frightening at times, he's offering an olive branch and saying he'll change. The unacknowledged meaning is that his meeting with the psychiatrist has made him realise his suppressed love for her has had a damaging effect on her and that he's now willing to step aside and let her go with Max.
I think Max was unhappy because he'd hoped she would marry him that week and go and live with him in Italy but by reconciling with Nicholas she'd be returning to her world of music, making a relationship with him that much harder. I don't think he suspected the truth about Nicholas.

When Larsen comes visiting and plays the Beethoven sonata. Did Nicholas think Larsen knew about his lashing out at Francesca at that point and was angry for that? Did he suspect Larsen knew his true feelings? Did he even know himself? He looked like he was really in pain when Larson guessed...

I think at first he just feels angry at Larsen prying into his private affairs- psychiatrists were considered quacks back then and Nicholas is the ultimate old-fashioned Englishman still living in his Victorian styled home. And N is a clever man- he'd know they'd have discussed such a key event. But from N's point of view, all that Larsen actually sees is Nicholas being angry at the music which was played when he tried to hit her hands- that could easily mean he's just worried he'll be in trouble for physical assault as much as anything else, but by now the audience and Larsen are on the same page about his suppressed love. I think we're meant to believe that Nicholas didn't understand his true feelings until the moment Larsen says at the very end of the scene "Now I know what she means to you". That way this is a key turning point in his character development and juxtaposed with the next scene where he's at last nice to Francesca. The psychiatrist reveals both F&N's true nature to themselves.

for the famous pre-hand-smashing speech... at some point Nicholas says "I can't live without you...you must know that". How would she, as up to that point he had consistently been cold and distant to her....

Even for a melodrama this is a badly written scene- his words here are unequivocally romantic and yet at this point he's still supposed to be in denial. It would have made more sense for him to still think he's doing this for her benefit, not his. Never mind whether people would really say these words, the words don't obey the internal logic of the film. But the one outwardly interested gesture he has shown towards her is having her portrait painted. For a gothic melodrama that's usually a sign of romantic attachment I suppose.

At the very end, when all three men are awaiting Francesca in the hallway...did the doctor know at that point whom she was about to choose?

I sincerely hope so, otherwise that means they haven't talked through the very important consequences of a previously fragile woman going off with her erstwhile tormentor. Had Larsen not talked about her next step in life that would be a gross dereliction of a psychiatrist's duties, no matter how unrealistic the miracle he's managed to pull off in the short time span. But the fact that he left her playing the music which first revealed to Larsen Nicholas' true feelings is, I feel, the big hint that they've just been discussing him and that he therefore knew who she'd chosen.

But all in all, the motivations and behaviour of characters don't bear too much scrutiny in this film because of the major switch in how Francesca resolves her problems. The switch works cinematically because Mason is such a charismatic actor, but in terms of characters' motivations or good real life choices it's all wrong.

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You probably know that Mason suggested the different ending. He told Muriel Box that the original ending was a bit dull, and I'm so glad that he did. I think if they had stayed with the original (Francesca choosing Peter Gaye), it would have been such a let down. It seems obvious to me that Nicholas has been falling in love with his ward for a long time, but tries to repress and hide his feelings. It will be rather a scandal when revealed, as he is her guardian, her second cousin, etc. Yes, I think Larsen would have known by the end of the therapy sessions which man she loved. I think that is also why he chose the Beethoven piece, the very same one she was playing when Nicholas tried to smash her hands. Remember when Larsen goes to see Nicholas, who becomes enraged and breaks the record, Larsen says to Nicholas, "I know what she is to you." Some viewers were unhappy with the ending, arguing that Nicholas was a control freak and Francesca should have gone off with one of her other suitors. I disagree. Firstly, there is no evidence that Peter ever was in love with her, indeed, he makes statements to that effect. As for Max, he is perfectly happy to see her sacrifice her music for, what may be to him, a brief affair. It is Nicholas who, in a true sense, sets her free to pursue music, her first love. Of course, he is very jealous and controlling, and no one would argue that their marriage will be a placid one. Finally, what woman would not choose James Mason, who was beyond handsome and sexy in his time? One more thing, I think that Francesca was also in denial about her real feelings for Nicholas.

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