I use FreeCAD to design them - that’s my tool of choice but, not everyone is interested in learning it and, most likely, prefer using a typical drawing program.
I’ve tried various Drawing programs with varying degree’s of Success (and Trouble) - they all seem to require some messing around with XML, re-scaling and… list goes on…
Sure, learning FreeCAD can take a bit of time but, for a simple PCB, it’s pretty easy and doesn’t require much education.
I made a quick video… Showing how to make the perimeter. For Cutouts, I’ll make another video… At YouTube Custom PCB using FreeCAD