How to create dialog box with disabled edit fields?

Hello,

I'd like to write a function, with input would be cell (see example image below)

and the output should be a dialog box with a similar structure, only with the following "rules":

1. fisrt coloumn (key) - should be type 'text'.
2. 2nd coloumn (value - local) - should be type edit box (Enable = ON)
3. 3rd coloumn (value - golden) - should be type edit box (Enable = OFF)

And of course the typical "Ok" & "Cancel" buttons/

Can this be done somehow?

P.S obviously, I'm looking for a generic solution. not something specific for the example above.

THANKS !!!