I made a sketch a few months ago, saved it, and uploaded it. But then I had to tweak it to make it functional, and I didn't save the tweak. It's been so long I can't for the life of me remember what I did.
Is there a way to download the current sketch off of a board back into the IDE?
No. The best that could be done would be to download the binary executable file but that is not the source code for the sketch and cannot be loaded into the IDE
Sure, but you would have to go through the object code to figure it out. Few people have the knowledge and patience required though. There's probably a tool that will do it for you, but even then, all the variable and function names will be machine generated gibberish.
Not automatically. If you were experienced enough with AVR machine code then you could disassemble it and maybe you could create a sketch that did exactly the same as the binary, but it would not be the original sketch and you would not be asking this question