If your ssh "connection refused" error is due to a problem with the Raspbian host's ssh keys (and one way to find out is to update them), you can replace them without booting into Raspbian if you have access to a running Linux host, which I will call a "helper" host. (Note: I went this route because there aren't safe/supported solutions I could find for mounting Linux ext4 partitions in 'writable' mode on macOS).
Your Linux helper host could be Raspbian running on another Pi, Linux running on PC hardware, or if you only have a Windows or Mac host, it could be guest virtual machine running Linux with VirtualBox, etc... Assuming
Assuming you have a way to mount the Raspbian media on that host, it's easy to reconfigure the SSH keys by simply overwriting them, because virtually all Linux distributions, (including Raspbian), have openssh installed, which offers the same set of tools.
HOW TO REPLACE SSH HOST KEYS ON RASPBIAN WITHOUTW/O BOOTING INTO IT