I've just read through this thread, and there are some great comments. My two cents:
Composing is much like writing a novel. Music is the language we use to create, and it has a grammar.
But music theory isn't really the grammar of music. It has some similarities to grammar - both are taxonomies, the categorizing of discrete elements into categories: in language, we have nouns and verbs and such; in music we have scales, dominant chord functions, etc. We give names to these things... not because they need names to exist, but because it steers and refines our thinking.
I'm a composer, a teacher (of composition, among other things) and a writer (of theory books, among other things). When I'm writing a lesson for a magazine and I get stuck, I'm not thinking "I need a noun here". I'm thinking "I need another way to express this idea - because this one isn't working out". I don't turn to a grammar book - I turn to the resources that might help me find a new means of expression. That might be a dictionary, to make sure I'm using a word the right way, or a thesaurus to suggest synonyms that might better suit my purpose - or might stir my imagination to come up with a better way to say what I mean.
When I'm composing, I work the same way. Initially, I'm expressing an idea. I'm trying to get my thoughts down on paper as quickly as possible, to capture the inspiration. In this part of the process, theory works beneath the surface, at a subconscious level - I know what a major scale is, just as I know what a noun is. I know if I should call that note Bb or A# - it's ingrained, just as the noun/verb mechanics of speech are. So theory is a part of the idea generation part (stage 1) of composition, but not a conscious part.
The second stage of composition or writing is the editing and compilation phase. I've got ideas on paper - some are fully formed, others mere fragments. I need to take this raw material and turn it into something I'll be proud of. Essentially, I'm looking for weaknesses, and how to improve and polish what gems might be hidden in my inspiration.
Now I'm starting to use theory tools: first, analysis. How does what I've done hold together? If I'm writing a lesson for a magazine, I'm referring back to the outline I gave the editor, and I'm looking for any gaps - things I thought I would cover, but I didn't address well enough. In music, I'm looking at the broad form - how does it hang together? Are my sections supporting each other? Do the modulations make sense?
Now I've identified the flaws in the first draft. Time for the other tools - the thesaurus, or the rhyming dictionary, or whatever. How else can I say this to make better transitions? And here I'll use a combination of theory and creativity. I've identified a weak sentence, and found the key word I think should be changed. The thesaurus may suggest a word, and that triggers a chain of thought that leads me to something entirely different from Roget's suggestions. In composition, I identify a weak phrase, and work out variations using inversion, retrograde, diminution, augmentation, melodic inflection, etc - the same sort of laundry list a thesaurus might provide. I might use one of those suggestions directly... or the idea may lead me to other things.
The third stage is polishing it all up. In writing, I may be using a style guide. In music, I might be referencing works on orchestration to make sure I'm staying within proper ranges, or avoiding awkward trills and such. I might be labeling intervals and thinking about what Fux wrote, or I might be mapping chords against the circle of fifths to see geometric relationships.
The more you learn about structure, in any language, the more you can do with it. That doesn't mean you HAVE to do it. It simply means you're aware of the paths worn by those who came before you. You can walk them or avoid them. It's like taking a hike with a map - you don't have to stay on the trail, but knowing a bit about the terrain can certainly shorten your journey.
So I use theory quite a bit, but not all the time.