How do people have conversations in noise and make themselves understood? While many previous studies have investigated speaking and listening in isolation, this study focuses on the behaviour of pairs of individuals in an ecologically valid context. Specifically, we report the fine-grained dynamics of natural conversation between interlocutors of varying hearing ability (n = 30), addressing how different levels of background noise affect speech, movement, and gaze behaviours. We found that as noise increased, people spoke louder and moved closer together, although these behaviours provided relatively small acoustic benefit (0.32 dB speech level increase per 1 dB noise increase). We also found that increased noise led to shorter utterances and increased gaze to the speaker's mouth. Surprisingly, interlocutors did not make use of potentially beneficial head orientations. While participants were able to sustain conversation in noise of up to 72 dB, changes in conversation structure suggested increased difficulty at 78 dB, with a significant decrease in turn-taking success. Understanding these natural conversation behaviours could inform broader models of interpersonal communication, and be applied to the development of new communication technologies. Furthermore, comparing these findings with those from isolation paradigms demonstrates the importance of investigating social processes in ecologically valid multi-person situations.