I've been visiting Cosa Nostra occasionally for the past five or so years and it is always pleasant to visit. They have three floors, the basement is smoking and the design inspired from cellars, the ground floor is non-smoking and has a pleasant, well lit decor and the first floor is fine dining, which serves a different menu from the two lower floors.
My review for the fares on offer are restricted to the ground floor and basement restaurant menu. When they started out, they used to have superb salads, their caesar salad was quite popular. Over time however, I've seen its quality drop and price increase significantly. Next, the pizzas are also popular but I find the cheese they use to be almost inedible, I steer clear of their pizzas, even though the very first time I'd tried it, it wasn't bad then, but that was many years ago. This leaves their pastas, burgers and paninis. Their burgers (I've only had beef ones) are delish. Their paninis can be hit or miss, depending on which one you order. I've only ever had one of their pastas, the penne, and I was unimpressed. So in sum, try the burgers if you want a nice wholesome meal, but there are, of course, not very Italian.
Vegetarian options: your best best would be a salad (ask them to serve it without the chicken) or a vegetarian pasta (if memory serves me correctly they have atleast one of these) and the vegetarian panini. I think its called 'greek' or 'mediterranean' or something.
The one good thing that remains of high quality since they started is their icecream. My personal favorite is the 'After eight' flavor with a dollop of whipped cream. Their coffees and tea is good too.
Once one of my favorite restaurants in Lahore, though it remains a pleasant place in terms of ambience, it is not my go-to restaurant anymore, since I find the quality of food to have dropped along with a significant increase in price.
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